The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial.

PubMed

Moon, Rachel Y; Hauck, Fern R; Colson, Eve R; Kellams, Ann L; Geller, Nicole L; Heeren, Timothy; Kerr, Stephen M; Drake, Emily E; Tanabe, Kawai; McClain, Mary; Corwin, Michael J

2017-07-25

Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12

The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme.

PubMed

Mitchell, Edwin A; Cowan, Stephanie; Tipene-Leach, David

2016-11-01

Postneonatal mortality rates changed very little from 2000 until recently. There has been a decrease in mortality in New Zealand from 2009 to 2015. This study describes an infant Safe Sleep programme and postulates it is the cause for the recent decrease in deaths. The Safe Sleep programme involved as follows: a focus on preventing accidental suffocation, a 'blitz' approach to SUDI education, the targeted provision of portable infant Safe Sleep devices (ISSD) and the development of Safe Sleep policy across all district health boards (DHBs). Participation in the education 'blitz' by health professionals exceeded one in 23 live births, distribution of Safe Sleep leaflets exceeded two for every live birth, and over 16 500 ISSDs have been distributed to vulnerable infants. Postperinatal mortality fell 29% from 2009 to 2015 (2.8 to 2.0/1000 live births). The fall has been greatest for Māori and in regions with the most intensive programmes. The recent fall in postperinatal mortality has not happened by chance. It is likely that the components of end-stage prevention strategy, a focus on preventing accidental suffocation, the education 'blitz', the targeted supply of ISSDs and strengthened health policy, have all contributed to varying degrees. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Myths and Facts about SIDS and Safe Infant Sleep

MedlinePlus

... Environment? Babies Need Tummy Time! FAQs Myths and Facts Campaign Materials Explore the Campaign Key Moments in Campaign History Outreach Activities The Science of SIDS and Safe Infant Sleep Collaborators and ...

Qualitative Analysis of Infant Safe Sleep Public Campaign Messaging.

PubMed

Peacock, Nadine R; Altfeld, Susan; Rosenthal, Allison L; Garland, Caitlin E; Massino, Jill M; Smith, Sherri L; Rowe, Hillary L; Wagener, Sarah E

2018-03-01

The 1994 Back to Sleep public education campaign resulted in dramatic reductions in sleep-related infant deaths, but comparable progress in recent years has been elusive. We conducted qualitative analyses of recent safe sleep campaigns from 13 U.S. cities. Goals were to (a) determine whether the campaigns reflect the full range of American Academy of Pediatrics (AAP) 2011 safe sleep recommendations, (b) describe tone and framing of the messages (e.g., use of fear appeals), (c) describe targeting/tailoring of messages to priority populations, and (d) ascertain whether the campaigns have been evaluated for reach and/or effectiveness. Methods included computer-assisted analyses of campaign materials and key informant interviews. All campaigns included "ABC" (Alone, Back, Crib) messaging; many ignored other AAP recommendations such as breastfeeding, room-sharing, immunizations, and avoiding smoke exposure. Campaigns frequently targeted priority populations such as African Americans. Fear appeals were used in three quarters of the campaigns, and 60% of the fear-based campaigns used guilt/blame messaging. We did not find published evaluation data for any of the campaigns. More attention is needed in public education campaigns to the full range of AAP recommendations, and evaluations are needed to determine the impact of these interventions on knowledge, behavior, and health outcomes.

SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.

PubMed

2016-11-01

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS; International Classification of Diseases, 10th Revision [ICD-10], R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, the use of a firm sleep surface, room-sharing without bed-sharing, and the avoidance of soft bedding and overheating. Additional recommendations for SIDS reduction include the avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence is presented for skin-to-skin care for newborn infants, use of bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2016-2940). Copyright © 2016 by the American Academy of Pediatrics.

Sleep health education in pediatric community settings: rationale and practical suggestions for incorporating healthy sleep education into pediatric practice.

PubMed

Gruber, Reut; Cassoff, Jamie; Knäuper, Bärbel

2011-06-01

This article offers practical ways to incorporate healthy sleep education into pediatric practice and discusses key questions, barriers, and strategies associated with such efforts. The rationale for incorporating healthy sleep education in pediatric practice settings is presented, and desirable features of sleep education programs that may be implemented in pediatric practice are identified. Potential barriers are reviewed and strategies offered to overcome these barriers, such as developing resources applicable to healthy sleep education and practical information for pediatricians. Key factors regarding effectiveness of such interventional programs and key points relevant to successful healthy sleep education in pediatric practice are highlighted. Copyright © 2011. Published by Elsevier Inc.

Randomized Trial of a Children's Book Versus Brochures for Safe Sleep Knowledge and Adherence in a High-Risk Population.

PubMed

Hutton, John S; Gupta, Resmi; Gruber, Rachel; Berndsen, Jennifer; DeWitt, Thomas; Ollberding, Nicholas J; Van Ginkel, Judith B; Ammerman, Robert T

Sleep-related infant deaths have plateaued in the past decade, disproportionately affecting low socioeconomic status (SES) families. Printed materials are widely used for anticipatory guidance, yet none for safe sleep has been studied. We tested the efficacy of a specially designed children's book compared to brochures for safe sleep knowledge and adherence, which we hypothesized would be greater due to superior readability and engagement. This randomized controlled trial involved low-SES mothers (n = 282) enrolled in a home visiting program. Home visitors (n = 56) were randomly assigned to perform safe sleep teaching and assessments during 3 visits: third trimester, 1 week old, and 2 months old, exclusively utilizing a specially designed children's book or brochures, and surveys incorporating the American Academy of Pediatrics' safe sleep recommendations. Outcomes were safe sleep knowledge, adherence, and usefulness of materials, controlling for maternal health literacy. Safe sleep knowledge increased across all time points with no overall group difference, though gains for sleep-evocative and general health items varied. Odds of bed sharing were higher and exclusive crib use lower for the brochure group (P < .05). Mothers and home visitors reported similar usefulness, though home visitors reported greater dialogue via the book and mothers in the book group reported more book sharing with their baby. While a specially designed children's book and brochures were equally effective conveying aggregate safe sleep knowledge in low-SES mothers, adherence to exclusive crib use and avoiding bed sharing were greater in the book group, attributable to enhanced dialogue, readability and emotional engagement. Children's books are a promising mode of anticipatory guidance, warranting further investigation. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Back to Sleep, Tummy to Play

MedlinePlus

... Español Text Size Email Print Share Back to Sleep, Tummy to Play Page Content ​What are the 2 most important things to remember about safe sleep practices? Healthy babies are safest when sleeping on ...

ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations.

PubMed

Allen, Stephanie L; Howlett, Melissa D; Coulombe, J Aimée; Corkum, Penny V

2016-10-01

The ABCs of SLEEPING mnemonic was developed to serve as an organizing framework for common pediatric sleep recommendations. The mnemonic stands for 1) age appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) exercise and diet, 5) no electronics in the bedroom or before bed, 6) positivity 7) independence when falling asleep and 8) needs of child met during the day, 9) equal great sleep. This review examines the empirical evidence behind the practices and recommendations captured by the ABCs of SLEEPING mnemonic for children aged 1 to 12. A search was conducted of key electronic databases (PubMed, PsycINFO, CINAHL, & EMBASE) to identify English articles that included the concepts of sleep, insomnia, and/or bedtime. 77 articles were eligible for inclusion and were coded to extract key details and findings regarding the relations between sleep practices identified in the ABCs of SLEEPING mnemonic and sleep outcomes. Findings provided preliminary support for many of the recommendations that are commonly made to families regarding healthy sleep practices. However, more robust investigations are needed to better understand the causal contributions of healthy sleep practices to the onset and maintenance of children's sleep problems. Copyright © 2015 Elsevier Ltd. All rights reserved.

An analysis of attitude toward infant sleep safety and SIDS risk reduction behavior among caregivers of newborns and infants.

PubMed

Varghese, S; Gasalberti, D; Ahern, K; Chang, J C

2015-11-01

To explore beliefs and attitude toward infant sleep safety and sudden infant death syndrome (SIDS) risk reduction behaviors among caregivers of newborns and infants. A convenience sample comprised of 121 caregivers of newborns at Staten Island University Hospital completed a questionnaire. Despite an overall favorable attitude toward safe sleep practices, a majority disagreed with use of pacifiers (53%) and believed that swaddling (62%) as well as the use of home monitors (59%) are acceptable practices. The caregivers who recalled being taught about safe sleep had higher perception of infant vulnerability (P<0.001), more confidence in their ability to implement safe sleep behaviors (P<0.0006) and stronger belief that safe sleep behaviors are effective (P<0.01). Active caregiver education may result in more effective demonstration of safe sleep and SIDS risk reduction behaviors. Further study is needed to assess if favorable attitudes toward safe sleep practices correlate with actual demonstrated behaviors.

Children's Sleep and School Psychology Practice

ERIC Educational Resources Information Center

Buckhalt, Joseph A.; Wolfson, Amy R.; El-Sheikh, Mona

2009-01-01

Much contemporary research has demonstrated the multiple ways that sleep is important for child and adolescent development. This article reviews that research with an emphasis on how sleep parameters are related to school adjustment and achievement. Five areas of sleep research are reviewed to discern implications for practice with children using…

A Multispecies Approach to Co-Sleeping : Integrating Human-Animal Co-Sleeping Practices into Our Understanding of Human Sleep.

PubMed

Smith, Bradley P; Hazelton, Peta C; Thompson, Kirrilly R; Trigg, Joshua L; Etherton, Hayley C; Blunden, Sarah L

2017-09-01

Human sleeping arrangements have evolved over time and differ across cultures. The majority of adults share their bed at one time or another with a partner or child, and many also sleep with pets. In fact, around half of dog and cat owners report sharing a bed or bedroom with their pet(s). However, interspecies co-sleeping has been trivialized in the literature relative to interpersonal or human-human co-sleeping, receiving little attention from an interdisciplinary psychological perspective. In this paper, we provide a historical outline of the "civilizing process" that has led to current sociocultural conceptions of sleep as an individual, private function crucial for the functioning of society and the health of individuals. We identify similar historical processes at work in the formation of contemporary constructions of socially normative sleeping arrangements for humans and animals. Importantly, since previous examinations of co-sleeping practices have anthropocentrically framed this topic, the result is an incomplete understanding of co-sleeping practices. By using dogs as an exemplar of human-animal co-sleeping, and comparing human-canine sleeping with adult-child co-sleeping, we determine that both forms of co-sleeping share common factors for establishment and maintenance, and often result in similar benefits and drawbacks. We propose that human-animal and adult-child co-sleeping should be approached as legitimate and socially relevant forms of co-sleeping, and we recommend that co-sleeping be approached broadly as a social practice involving relations with humans and other animals. Because our proposition is speculative and derived from canine-centric data, we recommend ongoing theoretical refinement grounded in empirical research addressing co-sleeping between humans and multiple animal species.

Unhealthy sleep practices, conduct problems, and daytime functioning during adolescence.

PubMed

Lin, Wen-Hsu; Yi, Chin-Chun

2015-02-01

Although sleep has been linked to activities in various domains of life, one under-studied link is the relationship between unhealthy sleep practices and conduct problems among adolescents. The present study investigates the influence of adolescents' unhealthy sleep practices-short sleep (e.g., less than 6 h a day), inconsistent sleep schedule (e.g., social jetlag), and sleep problems-on conduct problems (e.g., substance use, fighting, and skipping class). In addition, this study examines unhealthy sleep practices in relationship to adolescent emotional well-being, defiant attitudes, and academic performance, as well as these three domains as possible mediators of the longitudinal association between sleep practices and conduct problems. Three waves of the Taiwan Youth Project (n = 2,472) were used in this study. At the first time-point examined in this study, youth (51% male) were aged 13-17 (M = 13.3). The results indicated that all three measures of unhealthy sleep practices were related to conduct problems, such that short sleep, greater social jetlag, and more serious sleep problems were concurrently associated with greater conduct problems. In addition, short sleep and sleep problems predicted conduct problems one year later. Furthermore, these three unhealthy sleep practices were differently related to poor academic performance, low levels of emotional well-being, and defiant attitudes, and some significant indirect effects on later conduct problems through these three attributes were found. Cultural differences and suggestions for prevention are discussed.

Safe Use Practices for Pesticides

Science.gov Websites

; Environment Human Health Animal Health Safe Use Practices Food Safety Environment Air Water Soil Wildlife Ingredients Low-Risk Pesticides Organic Pesticide Ingredients Pesticide Incidents Human Exposure Pet Exposure Home Page Pesticide Health and Safety Information Safe Use Practices for Pesticides Related Topics

Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution.

PubMed

Bartick, Melissa; Tomori, Cecília; Ball, Helen L

2018-04-01

Concerns about bedsharing as a risk for sudden infant death syndrome and other forms of sleep-associated infant death have gained prominence as a public health issue. Cardboard "baby boxes" are increasingly promoted to prevent infant death through separate sleep, despite no proof of efficacy. However, baby boxes disrupt "breastsleeping" (breastfeeding with co-sleeping) and may undermine breastfeeding. Recommendations enforcing separate sleep are based on 20th century Euro-American social norms for solitary infant sleep and scheduled feedings via bottles of cow's milk-based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance. Moreover, the focus on bedsharing neglects more potent risks such as smoking, drugs, alcohol, formula feeding, and poverty. Distribution of baby boxes may divert resources and attention away from addressing these other risk factors and lead to a false sense of security wherein we overlook that sudden unexplained infant deaths also occur in solitary sleep environments. Recognizing breastsleeping as the evolutionary and cross-cultural norm entails re-evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co-sleeping, investigating ways to safely minimize separation for formula-fed infants, and mitigating the potential harms of mother-infant separation when breastsleeping is disrupted. Resources would be better spent addressing such questions rather than on a feel-good solution such as the baby box. © 2017 John Wiley & Sons Ltd.

Safe sex self-efficacy and safe sex practice in a Southern United States College

PubMed Central

Addoh, Ovuokerie; Sng, Eveleen; Loprinzi, Paul D.

2017-01-01

Background: The purpose of this study was to assess the association between safe sex self-efficacy and safe-sex practice in a Southern college setting. Methods: Multivariable logistic regression models were used to examine the association between safe sex self-efficacy in four domains (mechanics, partner disapproval, assertiveness, intoxicants) and safe sex practice (outcome variable). Results: For every 1-unit increase in the composite condom use self-efficacy score, there was an 8% increase in the odds of being beyond the median safe-sex practice score (odds ration [OR]: 1.08, 95% CI: 1.02-1.15). Additionally, for every 1-unit increase in intoxicants self-efficacy score, there was a 31% increase in the odds of being beyond the median safe-sex practice score (OR: 1.31, 95% CI: 1.08-1.58). Conclusion: A greater degree of safe-sex self-efficacy is associated with increased odds of safe-sex practice. These findings are informative for the development of targeted approaches to foster safe-sex behavior in Southern US colleges. PMID:28326287

A Survey of Practicing Sleep Coaches.

PubMed

Ingram, David G; Mindell, Jodi A; Puzino, Kristina; Walters, Russel M

2018-01-01

Sleep coaches are individuals of various backgrounds who offer services to families struggling with behavioral childhood sleep problems. We conducted a survey of coaches to further elucidate scope of practice, practice patterns, geographic distribution, education, training, and beliefs regarding qualification requirements. A Web-based survey was completed by 142 individuals who identified as a sleep coach. Coaches were distributed across 17 countries and 5 continents. Overall, 65% of coaches served clients in countries beyond their home country. Within the United States, coaches were generally located in more affluent and well-educated zip codes near large metropolitan centers, 91% served clients beyond their home state, and 56% served clients internationally. Educational background varied across coaches (12% high school degree, 51% bachelor's degree, 32% master's degree, 2% doctoral degree, 1.5% JD degree). Few coaches (20%) were or had been licensed health care providers or carried malpractice insurance (38%). Coaches usually provided services for children < 4 months of age to about 6 years of age, and were much less likely to provide services for children with comorbid neurodevelopmental (32%) or significant medical disorders (19%). Coaches reported an average of 3 new and 6 total clients per week and working 20 hr per week on average. Most coaches (76%) felt that a formal sleep coach training program was the most important qualification for practice. These results highlight a diversity of background, training, and geographical distribution of sleep coaches, and may help inform discussions regarding guidelines for training and credentialing of sleep coaches.

Revisiting safe sleep recommendations for African-American infants: why current counseling is insufficient.

PubMed

Gaydos, Laura M; Blake, Sarah C; Gazmararian, Julie A; Woodruff, Whitney; Thompson, Winifred W; Dalmida, Safiya George

2015-03-01

The American Academy of Pediatrics recommends that children be placed in the supine position on firm bedding and not bed share with parents or other children. Health professionals increasingly understand that many African-American parents do not follow these recommendations, but little research exists on provider reactions to this non-compliance. This study was intended to better understand how low-income, African-American mothers understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. We conducted focus groups with 60 African-American, low-income, first-time mothers and telephone interviews with 20 providers serving these populations to explore provider counseling and patient decision making. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. Key reasons for non-compliance included perceived safety, convenience, quality of infant sleep and conflicting information from family members. Mothers often take measures intended to mitigate risk associated with noncompliance, instead increasing SIDS risk. Providers recognize that many mothers are non-compliant and attribute non-compliance largely to cultural and familial influence. However, few provider attempts are made to mitigate SIDS risks from non-compliant behaviors. We suggest that counseling strategies should be adapted to: (1) provide greater detailed rationale for SIDS prevention recommendations; and (2) incorporate or acknowledge familial and cultural preferences. Ignoring the reasons for sleep decisions by African-American parents may perpetuate ongoing racial/ethnic disparities in SIDS.

Sleep Practices of University Students Living in Residence

ERIC Educational Resources Information Center

Qin, Pei; Brown, Cary A.

2017-01-01

Sleep plays an important role in both students' academic and personal life. Despite widespread sleep problems among young adults, few studies focus on higher education students living in campus residence. This study investigated residence-living students' sleep patterns, sleep promoting practices, sources of help seeking, and preferred ways to…

Safe sleep, day and night: mothers' experiences regarding infant sleep safety.

PubMed

Lau, Annie; Hall, Wendy

2016-10-01

To explore Canadian mothers' experiences with infant sleep safety. Parents decide when, how and where to place their infants to sleep. It is anticipated that they will follow international Sudden Infant Death Syndrome prevention sleep safety guidelines. Limited evidence is available for how parents take up guidelines; no studies have explored Canadian mothers' experiences regarding infant sleep safety. An inductive qualitative descriptive study using some elements of grounded theory, including concurrent data collection and analysis and memoing. Semi-structured interviews and constant comparative analysis were employed to explore infant sleep safety experiences of 14 Canadian mothers residing in Metro Vancouver. Data collection commenced in December 2012 and ended in July 2013. The core theme, Infant Sleep Safety Cycle, represents a cyclical process encompassing sleep safety from the prenatal period to the first six months of infants' lives. The cyclical process includes five segments: mothers' expectations of sleep safety, their struggles with reality as opposed to maternal visions, modifications of expectations, provision of rationale for choices and shifts in mothers' views of infants' developmental capabilities. Mothers' experiences were influenced by four factors: perceptions of everyone's needs, familial influences, attitudes and judgments from outsiders and resource availability and accessibility. To manage infants' sleep, mothers reframed sleep safety guidelines and downplayed the risk of Sudden Infant Death Syndrome for all forms of sleep at all times. Healthcare providers can support mothers' efforts to manage their infants' sleep challenges. During prenatal and postpartum periods, providers' interventions can influence mothers' efforts to adhere to sleep safety principles. The study findings support healthcare providers' efforts to assist mothers to modify expectations and develop strategies to support sleep safety principles while acknowledging their

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

PubMed Central

Kapur, Vishesh K.; Auckley, Dennis H.; Chowdhuri, Susmita; Kuhlmann, David C.; Mehra, Reena; Ramar, Kannan; Harrod, Christopher G.

2017-01-01

Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as “good practice statements”, that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations. Recommendations: The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation. Recommendations: We recommend that clinical tools, questionnaires and prediction

Infant sleep position practices 2 years into the "back to sleep" campaign.

PubMed

Gibson, E; Dembofsky, C A; Rubin, S; Greenspan, J S

2000-05-01

Since the 1992 American Academy of Pediatrics (AAP) recommendation to put babies to sleep in the nonprone position and the subsequent 1994 "Back to Sleep" campaign, the U.S. rate of sudden infant death syndrome (SIDS) has decreased more than 40%. This study reports sleep position practices in the greater Philadelphia area during 1996 and 1997. Four hundred and ten parents of infants 6 months of age or less answered a questionnaire by interview in Philadelphia clinics and private pediatric offices from December 1995 through February 1997. Sleep position practices and other SIDS risk factors were measured among demographic groups and compared with reported rates in a similar population from 1993 and 1994. Data were analyzed by Chi square after analysis of correlation coefficients. Significance is reported at p < 0.05. Seventy-two percent of all infants surveyed slept nonprone (NP) compared to 31.8% in 1993 and 59.1% in 1994. The population was 61% African-American (AA), 62% clinic patients. The breast feeding rate was 31%, maternal smoking 17%, and cosleeping 46%. AA infants (67% vs. 82%), infants receiving care at a clinic (66% vs. 84%), and infants > 3 months old (65% vs. 76%) are less likely to be placed nonprone. Most parents who place infants on their back report it was recommended by a medical professional (56%). The majority of those placing infants prone do so because their infant is more comfortable or sleeps better (65%), although 73% said their physician/nurse discussed sleep position with them. Nonprone sleeping continues to increase since the initiation of the "Back to Sleep" campaign. Disparity between some demographic groups persists. An excessive number of African-American families and clinic families still choose a prone sleep position. Many who do so cite increased infant comfort, despite knowledge of the AAP recommendation.

Development of the athlete sleep behavior questionnaire: A tool for identifying maladaptive sleep practices in elite athletes

PubMed Central

Driller, Matthew W; Mah, Cheri D; Halson, Shona L

2018-01-01

Introduction Existing sleep questionnaires to assess sleep behaviors may not be sensitive in determining the unique sleep challenges faced by elite athletes. The purpose of the current study was to develop and validate the Athlete Sleep Behavior Questionnaire (ASBQ) to be used as a practical tool for support staff working with elite athletes. Methods 564 participants (242 athletes, 322 non-athletes) completed the 18-item ASBQ and three previously validated questionnaires; the Sleep Hygiene Index (SHI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A cohort of the studied population performed the ASBQ twice in one week to assess test-retest reliability, and also performed sleep monitoring via wrist-actigraphy. Results Comparison of the ASBQ with existing sleep questionnaires resulted in moderate to large correlations (r=0.32 - 0.69). There was a significant difference between athletes and non-athletes for the ASBQ global score (44±6 vs. 41±6, respectively, p<0.01) and for the PSQI, but not for the SHI or the ESS. The reliability of the ASBQ was acceptable (ICC=0.87) when re-tested within 7 days. There was a moderate relationship between ASBQ and total sleep time (r=-0.42). Conclusion The ASBQ is a valid and reliable tool that can differentiate the sleep practices between athletes and non-athletes, and offers a practical instrument for practitioners and/or researchers wanting to evaluate the sleep behaviors of elite athletes. The ASBQ may provide information on areas where improvements to individual athletes’ sleep habits could be made. PMID:29796200

Safe injection practice among health care workers, Gharbiya, Egypt.

PubMed

Ismail, Nanees A; Aboul Ftouh, Aisha M; El Shoubary, Waleed H

2005-01-01

A cross-sectional study was conducted in 25 health care facilities in Gharbiya governorate to assess safe injection practices among health care workers (HCWs). Two questionnaires, one to collect information about administrative issues related to safe injection and the other to collect data about giving injections, exposure to needle stick injuries, hepatitis B vaccination status and safe injection training. Practices of injections were observed using a standardized checklist. The study revealed that there was lack of both national and local infection control policies and lack of most of the supplies needed for safe injection practices. Many safe practices were infrequent as proper needle manipulation before disposal (41%), safe needle disposal (47.5%), reuse of used syringe & needle (13.2%) and safe syringe disposal (0%). Exposure to needle stick injuries were common among the interviewed HCWs (66.2%) and hand washing was the common post exposure prophylaxis measure (63.4%). Only 11.3% of HCWs had full course hepatitis B vaccination. Infection control -including safe injections- training programs should be afforded to all HCWs.

Physician Practice Information: The Practice Expenses and Characteristics of Sleep Medicine as Compared with Other AMA-Recognized Medical Specialties

PubMed Central

Blehart, Caroline

2009-01-01

Summary: This report introduces the Physician Practice Information (PPI) Survey and its findings. Background information on the PPI Survey is explained, as is the Survey's importance to the field of sleep medicine. Statistics reported by the Survey regarding Practice Expenses per Hour (PE/HR) for various specialties are analyzed in comparison with those reported specifically for sleep medicine. The similarities and differences between sleep medicine and all other medical specialties surveyed in terms of practice characteristics are also discussed. Analysis of PE/HR data found that sleep medicine payroll practice expenses are closest to those of obstetrics/gynecology, likely due to the employment of technologists in both fields. Regarding supplies and equipment expenses, sleep medicine is most similar to radiology, cardiology, and spine surgery, probably due to the use of disposable medical supplies. In terms of total PE/HR (less separately billable), sleep medicine is most like obstetrics/gynecology, orthopedic surgery, and otolaryngology. The full cause of this is undeterminable from the PPI Survey. Some areas of dissimilarity in regard to the practice characteristics of sleep physicians and all physicians surveyed across all specialties were found. Most of these fell in the area of “practice size and function of non-physician personnel.” Overall, the results of this section of the PPI Survey show that sleep medicine is practiced in a manner similar to that of the various specialty fields of all physicians surveyed across all specialties but still maintains some unique practice characteristics. Citation: Blehart C. Physician practice information: the practice expenses and characteristics of sleep medicine as compared with other AMA-recognized medical specialties. J Clin Sleep Med 2009;5(6):E1-E11.

Strategies and challenges for safe injection practice in developing countries.

PubMed

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, Kc Vikash

2013-01-01

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.

Strategies and challenges for safe injection practice in developing countries

PubMed Central

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, KC Vikash

2013-01-01

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of “Safe Injection Global Network (SIGN)” was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice. PMID:23662018

Cultural Differences in Sleeping Practices--Helping Early Childhood Educators Understand.

ERIC Educational Resources Information Center

Gonzalez-Mena, Janet; Bhavnagri, Navaz Peshotan

2001-01-01

Discusses cultural differences in sleeping practices, focusing on how child caregivers can provide developmentally appropriate and culturally sensitive care. Describes co-sleeping as an accepted practice in many cultures with several benefits. Discusses the role of cultural values, beliefs, priorities, and goals and the importance of…

Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. American Sleep Disorders Association.

PubMed

1995-07-01

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association (ASDA), provide recommendations for the practice of sleep medicine in North American with regards to the use of oral appliances for the treatment of snoring and obstructive sleep apnea. Oral appliances have been developed for the treatment of snoring and have been applied to the treatment of obstructive sleep apnea, a syndrome associated with morbidity. Based on a review of the relevant scientific literature, the Standards of Practice Committee of the ASDA has developed guidelines describing the use of oral appliances for the treatment of snoring and obstructive sleep apnea in adults.

Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice.

PubMed

Howell, D; Oliver, T K; Keller-Olaman, S; Davidson, J R; Garland, S; Samuels, C; Savard, J; Harris, C; Aubin, M; Olson, K; Sussman, J; MacFarlane, J; Taylor, C

2014-04-01

Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.

Safe delivery practices: experience from cross-sectional data of Bangladeshi women.

PubMed

Kabir, M A; Goh, Kim-Leng; Khan, M M H; Al-Amin, Abul Quasem; Azam, Mohammad Nurul

2015-03-01

This study examines the safe delivery practices of Bangladeshi women using data on 4905 ever-married women aged 15 to 49 years from the 2007 Bangladesh Demographic and Health Survey. Variables that included age, region of origin, education level of respondent and spouse, residence, working status, religion, involvement in NGOs, mass media exposure, and wealth index were analyzed to find correlates of safe delivery practices. More than 80% of the deliveries took place at home, and only 18% were under safe and hygienic conditions. The likelihood of safe deliveries was significantly lower among younger and older mothers than middle-aged mothers and higher among educated mothers and those living in urban areas. Economically better-off mothers and those with greater exposure to mass media had a significantly higher incidence of safe delivery practices. A significant association with religion and safe delivery practices was revealed. Demographic, socioeconomic, cultural, and programmatic factors that are strongly associated with safe delivery practices should be considered in the formulation of reproductive health policy. © 2012 APJPH.

Sleep Apnea (For Parents)

MedlinePlus

... Safe Videos for Educators Search English Español Obstructive Sleep Apnea KidsHealth / For Parents / Obstructive Sleep Apnea What's ... How Is Sleep Apnea Treated? Print What Is Sleep Apnea? Brief pauses in breathing during sleep are ...

Implementing AORN recommended practices for a safe environment of care.

PubMed

Hughes, Antonia B

2013-08-01

Providing a safe environment for every patient undergoing a surgical or other invasive procedure is imperative. AORN's "Recommended practices for a safe environment of care" provides guidance on a wide range of topics related to the safety of perioperative patients and health care personnel. The recommendations are intended to provide guidance for establishing best practices and implementing safety measures in all perioperative practice settings. Perioperative nurses should be aware of risks related to musculoskeletal injuries, fire, equipment, latex, and chemicals, among others, and understand strategies for reducing the risks. Evidence-based recommendations can give practitioners the tools to guide safe practice. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

12 CFR 1.5 - Safe and sound banking practices; credit information required.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Safe and sound banking practices; credit... TREASURY INVESTMENT SECURITIES § 1.5 Safe and sound banking practices; credit information required. (a) A national bank shall adhere to safe and sound banking practices and the specific requirements of this part...

12 CFR 1.5 - Safe and sound banking practices; credit information required.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Safe and sound banking practices; credit... TREASURY INVESTMENT SECURITIES § 1.5 Safe and sound banking practices; credit information required. (a) A national bank shall adhere to safe and sound banking practices and the specific requirements of this part...

12 CFR 1.5 - Safe and sound banking practices; credit information required.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Safe and sound banking practices; credit... TREASURY INVESTMENT SECURITIES § 1.5 Safe and sound banking practices; credit information required. (a) A national bank shall adhere to safe and sound banking practices and the specific requirements of this part...

12 CFR 1.5 - Safe and sound banking practices; credit information required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Safe and sound banking practices; credit... TREASURY INVESTMENT SECURITIES § 1.5 Safe and sound banking practices; credit information required. (a) A national bank shall adhere to safe and sound banking practices and the specific requirements of this part...

12 CFR 1.5 - Safe and sound banking practices; credit information required.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Safe and sound banking practices; credit... TREASURY INVESTMENT SECURITIES § 1.5 Safe and sound banking practices; credit information required. (a) A national bank shall adhere to safe and sound banking practices and the specific requirements of this part...

Relationship between parent knowledge of child sleep, and child sleep practices and problems: A pilot study in a children's hospital cohort.

PubMed

McDowall, Philippa S; Elder, Dawn E; Campbell, Angela J

2017-08-01

To describe parent reports of sleep practices, and examine associations with parent knowledge of child sleep, and whether children's sleep practices differ between parents who underestimated, overestimated or accurately estimated children's sleep needs. Parents of children aged 2-12 years (n = 115) attending hospital inpatient or day wards were approached and asked to report child sleep routines, sleep problems, parent education, household income and parent knowledge of child sleep via questionnaire. Younger age was associated with earlier bedtimes and wake times, shorter sleep latencies, longer sleep durations and greater sleep problems (P < 0.05). Parents from higher income homes reported earlier bedtimes and wake times, shorter sleep latencies and fewer sleep problems (P < 0.05). Parents with higher education reported shorter sleep latencies (P < 0.05). Parents with greater knowledge about child sleep reported earlier weekday and weekend bedtimes (r s  ≥ 0.26) and wake times (r s  ≥ 0.21) and greater consistency between their child's weekend and weekday sleep routines (P < 0.05). In comparison with parents who correctly estimated their child's sleep needs: parents who underestimated reported later weekday bedtimes (on average, 46 min), and longer sleep latencies (17 min); parents who overestimated reported longer sleep latencies (22 min). These findings remained significant when controlling for child age (P < 0.05). Parents with increased sleep knowledge, higher incomes and higher levels of education were more likely to report earlier bedtimes, wake times and more consistent sleep routines for their children. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Simplified sleep restriction for insomnia in general practice: a randomised controlled trial.

PubMed

Falloon, Karen; Elley, C Raina; Fernando, Antonio; Lee, Arier C; Arroll, Bruce

2015-08-01

Insomnia is common in primary care. Cognitive behavioural therapy for insomnia (CBT-I) is effective but requires more time than is available in the general practice consultation. Sleep restriction is one behavioural component of CBT-I. To assess whether simplified sleep restriction (SSR) can be effective in improving sleep in primary insomnia. Randomised controlled trial of patients in urban general practice settings in Auckland, New Zealand. Adults with persistent primary insomnia and no mental health or significant comorbidity were eligible. Intervention patients received SSR instructions and sleep hygiene advice. Control patients received sleep hygiene advice alone. Primary outcomes included change in sleep quality at 6 months measured by the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and sleep efficiency (SE%). The proportion of participants reaching a predefined 'insomnia remission' treatment response was calculated. Ninety-seven patients were randomised and 94 (97%) completed the study. At 6-month follow-up, SSR participants had improved PSQI scores (6.2 versus 8.4, P<0.001), ISI scores (8.6 versus 11.1, P = 0.001), actigraphy-assessed SE% (difference 2.2%, P = 0.006), and reduced fatigue (difference -2.3 units, P = 0.04), compared with controls. SSR produced higher rates of treatment response (67% [28 out of 42] versus 41% [20 out of 49]); number needed to treat = 4 (95% CI = 2.0 to 19.0). Controlling for age, sex, and severity of insomnia, the adjusted odds ratio for insomnia remission was 2.7 (95% CI = 1.1 to 6.5). There were no significant differences in other outcomes or adverse effects. SSR is an effective brief intervention in adults with primary insomnia and no comorbidities, suitable for use in general practice. © British Journal of General Practice 2015.

Challenges of safe medication practice in paediatric care--a nursing perspective.

PubMed

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices.

PubMed

Defendorf, Charles M; Paul, Sindy; Scott, George J

2018-05-01

Hepatitis C virus (HCV) infection poses significant adverse health effects. Improper use of vials, needles, syringes, intravenous bags, tubing, and connectors for injections and infusions is a current preventable cause of iatrogenic HCV transmission. Numerous cases have demonstrated the need for continued vigilance and the widespread nature of this iatrogenic infection risk across a variety of medical practice settings in the United States. Failure to implement the evidence-based Centers for Disease Control and Prevention (CDC) infection prevention guidelines exposes patients to preventable harm. The guidelines establish the requirement to notify patients in cases of suspected virus transmission, as well as to screen those patients who would not otherwise have been at risk for HCV seroconversion and other bloodborne pathogens. Legal and regulatory ramifications, including state, criminal, and tort laws, hold physicians and other health care professionals accountable to use safe injection practices. This article reviews the major health risks of HCV infection, significant effects of iatrogenic infection transmission, CDC guidelines for safe injection practices, and legal regulations and ramifications designed to promote safe injection practices.

Sleep practices among medical students in Pediatrics Department of University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria.

PubMed

Chinawa, J M; Chukwu, B F; Obu, H A

2014-01-01

Medical students are a population who are at great risk of having bad sleep practice and hygiene due to demanding clinical and academic activities. Poor sleep practices are a disturbing and destabilizing phenomenon. It affects many people and can affect the quality of work, performance and education of medical students. Determining the sleep practices and behaviors could be useful to establish a systematic mental health curriculum in medical schools. The objectives of this study is to describe sleep practices among undergraduate medical students in a Nigerian University. Sleep practices were investigated using a convenience sample of medical students from the University of Nigeria Teaching Hospital Ituku Ozalla, Enugu from October 2012 to February 2013. A total number of participants enrolled were 241 consisting of 150 male and 90 female medical students. However, 222 (response rate: 92.1%) completed and returned the questionnaire. The median number of hours of night sleep on a weekday and weekend were 6 and 7 h respectively. There was a significant correlation between the number of hours of sleep and use of caffeine (Spearman r = -0.148, P < 0.0321). Ninety two (45.3%) had a sleep latency of 10-30 min while 157 (70.7%) woke up 1-2 times/night. Twenty five (11.3%) experience unusual sleep practices such as sleep walking, talking or night terrors. Medical students in our institution have varying degrees of sleeping practice and behavior and this may affect academic performance.

Consolidation of episodic memories during sleep: long-term effects of retrieval practice.

PubMed

Racsmány, Mihály; Conway, Martin A; Demeter, Gyula

2010-01-01

Two experiments investigated the long-term effects of retrieval practice. In the retrieval-practice procedure, selected items from a previously studied list are repeatedly recalled. The typical retrieval-practice effects are considerably enhanced memory for practiced items accompanied by low levels of recall, relative to baseline, for previously studied items that are associated with the practiced items but were not themselves practiced. The two experiments demonstrated that the former effect persisted over 12 hr; the latter effect also persisted over 12 hr, but only if a period of nocturnal sleep occurred during the retention interval. We propose that consolidation processes occurring during sleep, and possibly featuring some form of off-line rehearsal, mediate these long-term effects of retrieval practice.

Heart rate variability during sleep following the practice of cyclic meditation and supine rest.

PubMed

Patra, Sanjib; Telles, Shirley

2010-06-01

Day time activities are known to influence the sleep on the following night. Cyclic meditation (CM) has recurring cycles. Previously, the low frequency (LF) power and the ratio between low frequency and high frequency (LF/HF ratio) of the heart rate variability (HRV) decreased during and after CM but not after a comparable period of supine rest (SR). In the present study, on thirty male volunteers, CM was practiced twice in the day and after this the HRV was recorded (1) while awake and (2) during 6 h of sleep (based on EEG, EMG and EGG recordings). This was similarly recorded for the night's sleep following the day time practice of SR. Participants were randomly assigned to the two sessions and all of them practiced both CM and SR on different days. During the night following day time CM practice there were the following changes; a decrease in heart rate, LF power (n.u.), LF/HF ratio, and an increase in the number of pairs of Normal to Normal RR intervals differing by more than 50 ms divided by total number of all NN intervals (pNN50) (P < 0.05, in all cases, comparing sleep following CM compared with sleep following SR). No change was seen on the night following SR. Hence yoga practice during the day appears to shift sympatho-vagal balance in favor of parasympathetic dominance during sleep on the following night.

Procedural performance following sleep deprivation remains impaired despite extended practice and an afternoon nap

PubMed Central

Kurniawan, Irma Triasih; Cousins, James Nicholas; Chong, Pearlynne L. H.; Chee, Michael W. L.

2016-01-01

The negative impact of sleep loss on procedural memory is well established, yet it remains unclear how extended practice opportunities or daytime naps can modulate the effect of a night of sleep deprivation. Here, participants underwent three training and test conditions on a sequential finger tapping task (SFTT) separated by at least one week. In the first condition they were trained in the evening followed by a night of sleep. Two further conditions took place where evening training was followed by a night of total sleep deprivation (TSD). One of the TSD conditions included a one-hour nap opportunity (15:00). Compared to the condition in which sleep was permitted, a night of TSD resulted in poorer performance across 4 practices the following day (10:00–19:00). The deleterious effect of a single night of TSD on procedural performance, was neither clearly alleviated by an afternoon nap nor by multiple practice opportunities. Interestingly, significant gains in performance were observed in all conditions after a one-week delay. Recovery sleep on subsequent nights thus appeared to nullify the effect of a single night of sleep deprivation, underscoring the importance of offline consolidation on the acquisition of procedural skill. PMID:27782172

Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?

PubMed

Farag, Amany; Tullai-McGuinness, Susan; Anthony, Mary K; Burant, Christopher

2017-01-01

This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices. The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices. This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital. Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices. Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

29 CFR 1926.1080 - Safe practices manual.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Diving General Operations Procedures § 1926.1080 Safe practices manual. Note: The requirements applicable to construction work under this section are...

Sleep Pattern and Sleep Hygiene Practices among Nigerian Schooling Adolescents

PubMed Central

Peter, Igoche David; Adamu, Halima; Asani, Mustafa O.; Aliyu, Ibrahim; Sabo, Umar A.; Umar, Umar I.

2017-01-01

Background: Sleep problems, especially in the adolescent stage of development, may be associated with excessive daytime sleepiness, impaired neurocognitive function, and a host of others leading to suboptimal performance. Objectives: To determine the pattern of sleep problems in school-going adolescents based on the bedtime problems; excessive daytime sleepiness; awakenings during the night and problems falling back asleep; regularity and duration of sleep; sleep-disordered breathing (BEARS) sleep screening algorithm. Materials and Methods: This is a cross-sectional descriptive study involving 353 secondary school-going adolescents in Kano metropolis. Subjects were selected for the study using multistage sampling technique. The study lasted from March 2015 to July 2015. Sleep problems were screened for using the BEARS sleep screening algorithm. Tables were used to present the qualitative data. The various BEARS sleep patterns were assessed, and comparison between stages of adolescence was done using Chi-square test (and Fisher's exact test where necessary). A significant association was considered at P < 0.05. Results: Of the 353 adolescents studied, 61.8% were males while 38.2% were females with male, female ratio of 1.6:1. Early, middle, and late adolescents constituted 13.9%, 39.9%, 46.2% respectively. BEARS sleep screening revealed awakenings during the night (34.6%) as the most common sleep-related problem reported, and this was followed by excessive daytime sleepiness (21.0%). Age-group dependent sleep duration was 7.19 ± 1.26, 7.13 ± 1.13, 7.16 ± 1.28, with P > 0.05. Although 62.9% of all the adolescents watched TV/play video games until 1 h before going to bed and this was highest in late adolescence, it was not statistically significantly associated with any of the sleep problems. Conclusion: Both the quality and quantity of sleep in Nigerian adolescents in Kano is suboptimal. Adolescent and sleep medicine should receive more attention in our

Associations of Parent Health Behaviors and Parenting Practices with Sleep Duration in Overweight and Obese Children

PubMed Central

Rea, Corinna J.; Smith, Renata L.; Taveras, Elsie M.

2016-01-01

Study Objectives: To examine the extent to which parent health behaviors and parenting practices are associated with school-age children's sleep duration. Methods: We surveyed 790 parents of children, aged 6 to 12 y, who had a body mass index (BMI) ≥ 90th percentile and were participating in a randomized controlled obesity trial. The main exposures were parent sleep duration, screen time and physical activity, parental limits placed on child TV viewing time and TV content, and parents' confidence regarding their ability to help their child get enough sleep. The primary outcome was child sleep duration. We used linear regression models to examine associations of parent behaviors and parenting practices with child sleep duration. Results: On average, children slept 9.2 h per night, whereas parents slept 6.9 h. Parents reported having an average of 1.9 h of screen time per day and 0.6 h of physical activity. There were 57.3% of parents who reported feeling very/extremely confident that they could help their child get enough sleep. In adjusted multivariate analyses, child sleep duration was 0.09 h/day (95% confidence interval: 0.03, 0.15) longer for each 1-h increment in parent sleep duration. Additionally, children whose parents reported being very/extremely confident they could help their child get age-appropriate sleep duration slept 0.67 h/day longer (95% confidence interval: 0.54, 0.81) than those whose parents were not/somewhat confident. Conclusions: Educating parents about their own sleep health and enhancing parent confidence to help their children get enough sleep are potential areas of intervention to increase child sleep duration. Citation: Rea CJ, Smith RL, Taveras EM. Associations of parent health behaviors and parenting practices with sleep duration in overweight and obese children. J Clin Sleep Med 2016;12(11):1493–1498. PMID:27655464

Bidirectional Associations between Bedtime Parenting and Infant Sleep: Parenting Quality, Parenting Practices, and their Interaction

PubMed Central

Philbrook, Lauren E.; Teti, Douglas M.

2016-01-01

In keeping with transactional conceptualizations of infant sleep development (Sadeh et al., 2010), the present study examined longitudinal, bidirectional linkages between bedtime parenting (direct observations of parenting practices and quality) and infant sleep across the first six months postpartum. In doing so, we also drew from Darling and Steinberg's (1993) conceptual model to examine parenting quality as a moderator of linkages between specific bedtime practices and infant sleep. Multilevel model analyses revealed that the strongest increases in infant nighttime sleep across the first six months occurred among infants of mothers who engaged in low levels of nursing at bedtime. Within-person linkages between mothers' emotional availability (EA) at bedtime, infant distress, and infant sleep were found, such that at time points when mothers were more emotionally available, infants were less distressed and slept more throughout the night. Several moderating effects of maternal EA on linkages between parenting practices and infant sleep were obtained that were consistent with predictions from Darling and Steinberg (1993). Higher maternal EA in combination with less close contact at bedtime was associated with more infant sleep across the night on average, and higher EA in combination with fewer arousing bedtime activities predicted more rapid increases in infant sleep with age. Finally, there was evidence of infant-driven effects, as higher infant nighttime distress predicted lower EA at subsequent time points. Results showcased the complex, reciprocal interplay between parents and infants in the development of infant sleep patterns and parenting behavior during the first six months postpartum. PMID:27010601

Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents.

PubMed

Charuvastra, Anthony; Cloitre, Marylene

2009-10-01

Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings.

Who Sleeps by Whom Revisited: A Method for Extracting the Moral Goods Implicit in Practice.

ERIC Educational Resources Information Center

Schweder, Richard A; And Others

1995-01-01

Explores the specific family practice of determining which family members share a bed or sleeping space. Discusses ways of extracting the moral principles implicit in the practice of arranging where family members sleep at night. Examines similarities and differences in the preferred moral goods of two culture regions--rural Hindu India and urban…

Infant Sleep Location and Breastfeeding Practices in the United States, 2011-2014.

PubMed

Smith, Lauren A; Geller, Nicole L; Kellams, Ann L; Colson, Eve R; Rybin, Denis V; Heeren, Timothy; Corwin, Michael J

2016-08-01

To describe the prevalence of breastfeeding and sleep location practices among US mothers and the factors associated with these behaviors, including advice received regarding these practices. A nationally representative sample of 3218 mothers who spoke English or Spanish were enrolled at a sample of 32 US birth hospitals between January 2011 and March 2014. Exclusive breastfeeding was reported by 30.5% of mothers, while an additional 29.5% reported partial breastfeeding. The majority of mothers, 65.5%, reported usually room sharing without bed sharing, while 20.7% reported bed sharing. Compared to mothers who room shared without bed sharing, mothers who bed shared were more likely to report exclusive breastfeeding (adjusted odds ratio 2.46, 95% confidence interval 1.76, 3.45) or partial breastfeeding (adjusted odds ratio 1.75, 95% confidence interval 1.33, 2.31). The majority of mothers reported usually room sharing without bed sharing regardless of feeding practices, including 58.2% of exclusively breastfeeding mothers and 70.0% of nonbreastfeeding mothers. Receiving advice regarding sleep location or breastfeeding increased adherence to recommendations in a dose response manner (the adjusted odds of room sharing without bed sharing and exclusive breastfeeding increased as the relevant advice score increased); however, receiving advice regarding sleep location did not affect feeding practices. Many mothers have not adopted the recommended infant sleep location or feeding practices. Receiving advice from multiple sources appears to promote adherence in a dose response manner. Many women are able to both breastfeed and room share without bed sharing, and advice to adhere to both of these recommendations did not decrease breastfeeding rates. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Sleep medicine knowledge, attitudes, and practices among medical students in Guangzhou, China.

PubMed

Luo, Miao; Feng, Yuan; Li, Taoping

2013-05-01

This study aimed to describe the knowledge, attitudes, and practices of Chinese medical students towards sleep medicine. The authors surveyed medical students at Southern Medical University in 2009. Students completed a questionnaire before and after attending a 3-h sleep disorders course. All 324 questionnaires were returned. Less than one half of the students were aware that restless legs syndrome, somniloquy, and teeth grinding are sleep disorders. Only a small percentage of students knew that sleep disorders are related to diabetes, anemia, hyperlipidemia, and attention deficit syndrome. After the 3-h sleep disorders course, the percentage of students who regarded snoring, restless legs syndrome, nightmares, and somniloquy as sleep disorders increased from 64.9 to 92.7 %, 40.8 to 64.4 %, 48.0 to 60.3 %, and 33.5 to 59.9 % (P < 0.001), respectively. Sleep problems were considered to be a significant issue by 93.8 % of the students. The students thought that people with sleep disorders should seek treatment. Of the students, 81.3 % were interested in sleep medicine. The students considered that it is necessary to set up specialized sleep medicine departments to manage sleep disorders. Of the students, 76.8 % thought they or their friends had sleep problems, and 44.8 % consulted physicians about sleep problems. Greater than two thirds of the students (67.1 %) did not have formal education about sleep medicine. Few students were aware of medical schools offering a course in sleep medicine. Most of the students liked learning in the form of elective courses, lectures, or online course. The students also realized that having sleep medicine knowledge is needed as a physician. Chinese medical students attached importance to sleep disorders, but knew little about sleep disorders. Knowledge of sleep medicine can be improved with a short training course.

Bidirectional associations between bedtime parenting and infant sleep: Parenting quality, parenting practices, and their interaction.

PubMed

Philbrook, Lauren E; Teti, Douglas M

2016-06-01

In keeping with transactional conceptualizations of infant sleep development (Sadeh, Tikotzky, & Scher, 2010), the present study was an examination of longitudinal, bidirectional linkages between bedtime parenting (through direct observations of parenting practices and quality) and infant sleep across the first 6 months postpartum. In doing so, we also drew from Darling and Steinberg's (1993) conceptual model to examine parenting quality as a moderator of linkages between specific bedtime practices and infant sleep. Multilevel model analyses revealed that the strongest increases in infant nighttime sleep across the first 6 months occurred among infants of mothers who engaged in low levels of nursing at bedtime. Within-person linkages between mothers' emotional availability (EA) at bedtime, infant distress, and infant sleep were found, such that at time points when mothers were more emotionally available, infants were less distressed and slept more throughout the night. Several moderating effects of maternal EA on linkages between parenting practices and infant sleep were obtained that were consistent with predictions from Darling and Steinberg (1993). Higher maternal EA in combination with less close contact at bedtime was associated with more infant sleep across the night on average, and higher EA in combination with fewer arousing bedtime activities predicted more rapid increases in infant sleep with age. Finally, there was evidence of infant-driven effects, as higher infant nighttime distress predicted lower EA at subsequent time points. Results showcased the complex, reciprocal interplay between parents and infants in the development of infant sleep patterns and parenting behavior during the first 6 months postpartum. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015

PubMed Central

Auger, R. Robert; Burgess, Helen J.; Emens, Jonathan S.; Deriy, Ludmila V.; Thomas, Sherene M.; Sharkey, Katherine M.

2015-01-01

A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on the treatment of intrinsic circadian rhythm sleep-wake disorders. Available data allowed for positive endorsement (at a second-tier degree of confidence) of strategically timed melatonin (for the treatment of DSWPD, blind adults with N24SWD, and children/ adolescents with ISWRD and comorbid neurological disorders), and light therapy with or without accompanying behavioral interventions (adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia). Recommendations against the use of melatonin and discrete sleep-promoting medications are provided for demented elderly patients, at a second- and first-tier degree of confidence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insufficient or absent data. Areas where further research is needed are discussed. Citation: Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015. J Clin Sleep Med 2015;11(10):1199–1236. PMID:26414986

Comparison of Infant Sleep Practices in African-American and US Hispanic Families: Implications for Sleep-Related Infant Death.

PubMed

Mathews, Anita A; Joyner, Brandi L; Oden, Rosalind P; Alamo, Ines; Moon, Rachel Y

2015-06-01

African-American and Hispanic families share similar socioeconomic profiles. Hispanic rates of sleep-related infant death are four times lower than African-American rates. We conducted a cross-sectional, multi-modal (surveys, qualitative interviews) study to compare infant care practices that impact risk for sleep-related infant death in African-American and Hispanic families. We surveyed 422 African-American and 90 Hispanic mothers. Eighty-three African-American and six Hispanic mothers participated in qualitative interviews. African-American infants were more likely to be placed prone (p < 0.001), share the bed with the parent (p < 0.001), and to be exposed to smoke (p < 0.001). Hispanic women were more likely to breastfeed (p < .001), while African-American women were more knowledgeable about SIDS. Qualitative interviews indicate that, although African-American and Hispanic parents had similar concerns, behaviors differed. Although the rationale for infant care decisions was similar for African-American and Hispanic families, practices differed. This may help to explain the racial/ethnic disparity seen in sleep-related infant deaths.

Curiosity's Autonomous Surface Safing Behavior Design

NASA Technical Reports Server (NTRS)

Neilson, Tracy A.; Manning, Robert M.

2013-01-01

The safing routines on all robotic deep-space vehicles are designed to put the vehicle in a power and thermally safe configuration, enabling communication with the mission operators on Earth. Achieving this goal is made a little more difficult on Curiosity because the power requirements for the core avionics and the telecommunication equipment exceed the capability of the single power source, the Multi-Mission Radioisotope Thermoelectric Generator. This drove the system design to create an operational mode, called "sleep mode", where the vehicle turns off most of the loads in order to charge the two Li-ion batteries. The system must keep the vehicle safe from over-heat and under-heat conditions, battery cell failures, under-voltage conditions, and clock failures, both while the computer is running and while the system is sleeping. The other goal of a safing routine is to communicate. On most spacecraft, this simply involves turning on the receiver and transmitter continuously. For Curiosity, Earth is above the horizon only a part of the day for direct communication to the Earth, and the orbiter overpass opportunities only occur a few times a day. The design must robustly place the Rover in a communicable condition at the correct time. This paper discusses Curiosity's autonomous safing behavior and describes how the vehicle remains power and thermally safe while sleeping, as well as a description of how the Rover communicates with the orbiters and Earth at specific times.

EMS providers' perceptions of safety climate and adherence to safe work practices.

PubMed

Eliseo, Laura J; Murray, Kate A; White, Laura F; Dyer, Sophia; Mitchell, Patricia A; Fernandez, William G

2012-01-01

Occupational injuries are an important source of morbidity for emergency medical services (EMS) providers. Previous work has shown that employee perceptions of an organization's commitment to safety (i.e., safety climate) correlate with adherence to safe practices. To assess the association between perceived safety climate and compliance with safety procedures in an urban EMS system with >100,000 calls/year. EMS providers were issued a self-administered survey that included questions on demographics, years of experience, perceived safety climate, and adherence to safety procedures. Safety climate was assessed with a 20-item validated instrument. Adherence to safety procedures was assessed with a nine-item list of safety behaviors. Strict adherence to safety procedures was defined as endorsing "agree" or "strongly agree" on 80% of items. The effect of safety climate on compliance with safe practices was estimated using multiple logistic regression. One hundred ninety-six of 221 providers (89%) completed surveys; 74% were male; the median age was 36-40 years; and the median amount of experience was 8 years. One hundred twenty-seven of 196 respondents (65%) reported strict adherence to safe work practice. Factor analysis confirmed the original six-factor grouping of questions; frequent safety-related feedback/training was significantly associated with safe practices (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.01-4.51). EMS workers perceiving a high degree of perceived safety climate was associated with twofold greater odds of self-reported level of strict adherence to safe work practices. Frequent safety-related feedback/training was the one dimension of safety climate that had the strongest association with adherence to safe workplace behaviors.

How to Keep Your Sleeping Baby Safe

MedlinePlus

... mode Turn off more accessible mode Skip Ribbon Commands Skip to main content Turn off Animations Turn ... any of the recommendations listed. What You Can Do: Recommendations for Infant Sleep Safety Until their first ...

Obstructive sleep apnea among commercial motor vehicle drivers: using evidence-based practice to identify risk factors.

PubMed

Olszewski, Kimberly; Wolf, Debra

2013-11-01

Commercial motor vehicle driving is a hazardous occupation, having the third highest fatality rate among common U.S. jobs. Among the estimated 14 million U.S. commercial motor vehicle drivers, the prevalence of obstructive sleep apnea is reported to be 17% to 28%. Despite the identified increased prevalence of obstructive sleep apnea among commercial motor vehicle drivers, federal law does not require that they be screened for obstructive sleep apnea. This article presents an evidence-based practice change project; the authors developed, implemented, and evaluated a screening program to identify commercial motor vehicle drivers' risk for obstructive sleep apnea during commercial driver medical examinations. The results of this practice change indicated screening for obstructive sleep apnea during the commercial driver medical examination led to improved identification of obstructive sleep apnea risk among commercial motor vehicle drivers and should be a clinical standard in occupational health clinics. Copyright 2013, SLACK Incorporated.

Trust in Sources of Advice about Infant Care Practices: The SAFE Study.

PubMed

Hwang, Sunah S; Rybin, Denis V; Heeren, Timothy C; Colson, Eve R; Corwin, Michael J

2016-09-01

Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

30 CFR 250.456 - What safe practices must the drilling fluid program follow?

Code of Federal Regulations, 2010 CFR

2010-07-01

... INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Drilling Fluid Requirements § 250.456 What safe practices must the drilling fluid program follow... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What safe practices must the drilling fluid...

Safe Practices for Copy and Paste in the EHR

PubMed Central

Lehmann, Christoph U.; Michel, Jeremy; Solomon, Ronni; Possanza, Lorraine; Gandhi, Tejal

2017-01-01

Summary Background Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT). Objective To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste. Methods The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices. Results The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Conclusion Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate

Creating an Environment for Safe and Healthy Sleep in Child Care Programs

ERIC Educational Resources Information Center

Rose, Bobbie

2012-01-01

Along with nutrition, physical activity, and secure attachments, sleep is a basic requirement for a child's growth and brain development. Sleep is important for health and wellness, especially for growing infants and young children. Unfortunately, the amount of time children spend sleeping seems to be declining. If only sleep-deprived children…

Are baby hammocks safe for sleeping babies? A randomised controlled trial.

PubMed

Chiu, Karen; Tonkin, Shirley L; Gunn, Alistair J; McIntosh, Christine C

2014-07-01

Two reports of infants found dead after sleeping in baby hammocks have raised international concern about the safety of infant hammocks. We therefore tested whether hammock sleep affected oxygenation in infants, when they were at an age of high risk of sudden, unexpected infant death. Healthy, full-term 4- to 8-week-old infants were randomised to sleep either in a commercially available hammock (n = 14) or a standard bassinet (n = 9), and sleep state, oxygen desaturation (a fall in peripheral haemoglobin oxygen saturation (SpO2 ) ≥ 4%, for ≥ 4 sec from baseline to nadir), apnoea and hypopnoea, and mean SpO2 were analysed. There was no significant difference in mean SpO2 (both 98.5%) or rate of oxygen desaturation events between the hammock and the bassinet cot (mean ± SD, 24 ± 20 vs. 28 ± 23 events per hour), but infants slept less in the hammock (59 ± 31 vs. 81 ± 34 min, p < 0.02). When correctly used, the hammock sleep position did not compromise the upper airway of sleeping infants. The significance of shorter duration of sleep in the hammocks is unclear. These findings should not be applied to all baby hammocks, nor to older babies, particularly once the infant can roll. Given that it is not possible to predict when an infant will be able to roll, we strongly recommend that hammocks should not be used for unsupervised sleep. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report.

PubMed

Morgenthaler, Timothy I; Lee-Chiong, Teofilo; Alessi, Cathy; Friedman, Leah; Aurora, R Nisha; Boehlecke, Brian; Brown, Terry; Chesson, Andrew L; Kapur, Vishesh; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J; Zak, Rochelle

2007-11-01

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of

Sleep Bruxism in Respiratory Medicine Practice.

PubMed

Mayer, Pierre; Heinzer, Raphael; Lavigne, Gilles

2016-01-01

Sleep bruxism (SB) consists of involuntary episodic and repetitive jaw muscle activity characterized by occasional tooth grinding or jaw clenching during sleep. Prevalence decreases from 20% to 14% in childhood to 8% to 3% in adulthood. Although the causes and mechanisms of idiopathic primary SB are unknown, putative candidates include psychologic risk factors (eg, anxiety, stress due to life events, hypervigilance) and sleep physiologic reactivity (eg, sleep arousals with autonomic activity, breathing events). Although certain neurotransmitters (serotonin, dopamine, noradrenalin, histamine) have been proposed to play an indirect role in SB, their exact contribution to rhythmic masticatory muscle activity (RMMA) (the electromyography marker of SB) genesis remains undetermined. No specific gene is associated with SB; familial environmental influence plays a significant role. To date, no single explanation can account for the SB mechanism. Secondary SB with sleep comorbidities that should be clinically assessed are insomnia, periodic limb movements during sleep, sleep-disordered breathing (eg, apnea-hypopnea), gastroesophageal reflux disease, and neurologic disorders (eg, sleep epilepsy, rapid eye movement behavior disorder). SB is currently quantified by scoring RMMA recordings in parallel with brain, respiratory, and heart activity recordings in a sleep laboratory or home setting. RMMA confirmation with audio-video recordings is recommended for better diagnostic accuracy in the presence of neurologic conditions. Management strategies (diagnostic tests, treatment) should be tailored to the patient's phenotype and comorbidities. In the presence of sleep-disordered breathing, a mandibular advancement appliance or CPAP treatment is preferred over single occlusal splint therapy on the upper jaw. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Health Messaging and African-American Infant Sleep Location: A Randomized Controlled Trial

PubMed Central

Moon, Rachel Y; Mathews, Anita; Joyner, Brandi L.; Oden, Rosalind P.; He, Jianping; McCarter, Robert

2016-01-01

Background Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African-American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African-American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. Objectives To evaluate the impact of specific health messages on African-American parental decisions regarding infant sleep location. Methods We conducted a randomized, controlled trial of African-American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2–3 weeks, 2–3 months, and 5–6 months after the infant’s birth. Results 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95% CI 1.003, 1.006]) and last night (aOR 1.004 [95% CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p<0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p<0.001) and did not differ by group assignment. Conclusion African-American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants. PMID:27470122

Sleep-Related Improvements in Motor Learning Following Mental Practice

ERIC Educational Resources Information Center

Debarnot, Ursula; Creveaux, Thomas; Collet, Christian; Gemignani, Angelo; Massarelli, Raphael; Doyon, Julien; Guillot, Aymeric

2009-01-01

A wide range of experimental studies have provided evidence that a night of sleep may enhance motor performance following physical practice (PP), but little is known, however, about its effect after motor imagery (MI). Using an explicitly learned pointing task paradigm, thirty participants were assigned to one of three groups that differed in the…

The sleeping brain in Parkinson's disease: A focus on REM sleep behaviour disorder and related parasomnias for practicing neurologists.

PubMed

Bhidayasiri, Roongroj; Sringean, Jirada; Rattanachaisit, Watchara; Truong, Daniel D

2017-03-15

Sleep disorders are identified as common non-motor symptoms of Parkinson's disease (PD) and recently this recognition has been expanded to include parasomnias, encompassing not only REM sleep behaviour disorder (RBD), but also other non-REM forms. RBD, a prototypical parasomnia in PD, exists even in the prodromal stage of the disease, and is characterized by the presence of dream enactment behaviours occurring alongside a loss of normal skeletal muscle atonia during REM sleep. In contrast, non-REM parasomnias are more frequently observed in the late stage PD. However, the development of these disorders often overlaps and it is not uncommon for PD patients to meet the criteria for more than one type of parasomnias, thus making a clinical distinction challenging for practicing neurologists who are not sleep specialists. Indeed, clinical recognition of the predominant form of parasomnia does not just depend on video-polysomnography, but also on an individual physician's clinical acumen in delineating pertinent clinical history to determine the most likely diagnosis and proceed accordingly. In this review article, we highlight the various forms of parasomnias that have been reported in PD, including, but not limited to, RBD, with a focus on clinical symptomatology and implications for clinical practice. In addition, we review the differences in PD-related parasomnias compared to those seen in general populations. With advances in sleep research and better technology for ambulatory home monitoring, it is likely that many unanswered questions on PD-related parasomnias will soon be resolved resulting in better management of this nocturnal challenge in PD. Copyright © 2017 Elsevier B.V. All rights reserved.

Methodological strategies in using home sleep apnea testing in research and practice.

PubMed

Miller, Jennifer N; Schulz, Paula; Pozehl, Bunny; Fiedler, Douglas; Fial, Alissa; Berger, Ann M

2017-11-14

Home sleep apnea testing (HSAT) has increased due to improvements in technology, accessibility, and changes in third party reimbursement requirements. Research studies using HSAT have not consistently reported procedures and methodological challenges. This paper had two objectives: (1) summarize the literature on use of HSAT in research of adults and (2) identify methodological strategies to use in research and practice to standardize HSAT procedures and information. Search strategy included studies of participants undergoing sleep testing for OSA using HSAT. MEDLINE via PubMed, CINAHL, and Embase with the following search terms: "polysomnography," "home," "level III," "obstructive sleep apnea," and "out of center testing." Research articles that met inclusion criteria (n = 34) inconsistently reported methods and methodological challenges in terms of: (a) participant sampling; (b) instrumentation issues; (c) clinical variables; (d) data processing; and (e) patient acceptability. Ten methodological strategies were identified for adoption when using HSAT in research and practice. Future studies need to address the methodological challenges summarized in this paper as well as identify and report consistent HSAT procedures and information.

Safe practices and financial considerations in using oral chemotherapeutic agents.

PubMed

Bartel, Sylvia B

2007-05-01

Safe handling practices and financial concerns associated with oral chemotherapy in non-traditional settings are discussed. Oral chemotherapy may pose a risk to patients because of a narrow therapeutic index, complex dosing regimen, dispensing by community pharmacists without prescription order review by an oncology pharmacist or nurse, or self-administration in the home or another nontraditional setting, where patient monitoring is infrequent. Errors in prescribing, dispensing, and administration and patient or caregiver misunderstandings are potential problems with the use of oral chemotherapy that need to be addressed when developing safe practices. Changes in Medicare pharmaceutical reimbursement rates and rules need to be monitored because they have the potential to affect patient care and outcomes. Patient assistance programs and advocacy groups can help alleviate financial concerns associated with oral chemotherapy. Consensus guidelines specific to safe handling of oral chemotherapy in the home or other nontraditional setting need to be developed. Also, healthcare providers must understand reimbursement and provide direction to patients when patient assistance programs or advocacy groups can assist with the financial challenges of oral chemotherapy.

Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

PubMed Central

Sateia, Michael J.; Buysse, Daniel J.; Krystal, Andrew D.; Neubauer, David N.; Heald, Jonathan L.

2017-01-01

Introduction: The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults. Methods: The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, and patient values and preferences. Literature reviews are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations. The AASM Board of Directors approved the final recommendations. Recommendations: The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults, when such treatment is indicated. Under GRADE, a STRONG recommendation is one that clinicians should, under most circumstances, follow. A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients, but should not be construed as an indication of ineffectiveness. GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient, but rather, to the strength of

Association between sleep behavior and sleep-related factors among university students in Hong Kong.

PubMed

Suen, Lorna K P; Hon, K L Ellis; Tam, Wilson W S

2008-09-01

Sleep problems among university students are common; however, the association between many sleep-related factors and sleep behaviors is still unclear. The purpose of this study is to examine different sleep behaviors and sleep-related factors influencing such behaviors in university students. A descriptive survey was conducted on 400 university students in Hong Kong. The instruments for data collection consisted of the Pittsburgh Sleep Quality Index (PSQI), a sleep hygiene practice questionnaire, demographic data, and other sleep-related factors. The results reveal that 57.5% of the 400 university students are poor sleepers. Sex, year of study, sleep hygiene practice, and perceived adequate sleep in the past month all demonstrate significant associations with poor sleepers. A high prevalence of sleep-related problems among college students is confirmed and associated factors are identified. Students should be encouraged to follow sleep hygiene practice, adequate time management for academic and social activities, and suitable stress-relieving measures.

Sleep from an Islamic perspective

PubMed Central

BaHammam, Ahmed S.

2011-01-01

Sleep medicine is a relatively new scientific specialty. Sleep is an important topic in Islamic literature, and the Quran and Hadith discuss types of sleep, the importance of sleep, and good sleep practices. Islam considers sleep as one of the signs of the greatness of Allνh (God) and encourages followers to explore this important sign. The Quran describes different types of sleep, and these correspond with sleep stages identified by modern science. The Quran discusses the beneficial effects of sleep and emphasizes the importance of maintaining a pattern of light and darkness. A mid-day nap is an important practice for Muslims, and the Prophet Muhammad peace be upon him (pbuh) promoted naps as beneficial. In accordance with the practice and instructions of Muhammad (pbuh), Muslims have certain sleep habits and these sleep habits correspond to some of the sleep hygiene rules identified by modern science. Details during sleep include sleep position, like encouraging sleep on the right side and discouraging sleep in the prone position. Dream interpretation is an established science in the Islamic literature and Islamic scholars have made significant contributions to theories of dream interpretation. We suggest that sleep scientists examine religious literature in general and Islamic literature in particular, to understand the views, behaviors, and practices of ancient people about the sleep and sleep disorders. Such studies may help to answer some unresolved questions in sleep science or lead to new areas of inquiry. PMID:21977062

Sleep from an Islamic perspective.

PubMed

Bahammam, Ahmed S

2011-10-01

Sleep medicine is a relatively new scientific specialty. Sleep is an important topic in Islamic literature, and the Quran and Hadith discuss types of sleep, the importance of sleep, and good sleep practices. Islam considers sleep as one of the signs of the greatness of Allνh (God) and encourages followers to explore this important sign. The Quran describes different types of sleep, and these correspond with sleep stages identified by modern science. The Quran discusses the beneficial effects of sleep and emphasizes the importance of maintaining a pattern of light and darkness. A mid-day nap is an important practice for Muslims, and the Prophet Muhammad peace be upon him (pbuh) promoted naps as beneficial. In accordance with the practice and instructions of Muhammad (pbuh), Muslims have certain sleep habits and these sleep habits correspond to some of the sleep hygiene rules identified by modern science. Details during sleep include sleep position, like encouraging sleep on the right side and discouraging sleep in the prone position. Dream interpretation is an established science in the Islamic literature and Islamic scholars have made significant contributions to theories of dream interpretation. We suggest that sleep scientists examine religious literature in general and Islamic literature in particular, to understand the views, behaviors, and practices of ancient people about the sleep and sleep disorders. Such studies may help to answer some unresolved questions in sleep science or lead to new areas of inquiry.

Interactive eLearning - a safe place to practice.

PubMed

Einarson, Elisabeth; Moen, Anne; Kolberg, Ragnhild; Flingtorp, Gry; Linnerud, Eva

2009-01-01

Interactive web-based learning environment offers refreshing opportunities to create innovative solutions to explore and exploit informatics support on-the-job training. We report from a study where a hospital is created a interactive eLearning resource. The modules are creating a safe place to practice - to be used for introduction to the work and preparation for certification or re-certification of competencies.

Safe injection practice among health-care workers in Gharbiya Governorate, Egypt.

PubMed

Ismail, N A; Aboul Ftouh, A M; El-Shoubary, W H; Mahaba, H

2007-01-01

We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.

Adoption of sun safe workplace practices by local governments.

PubMed

Wallis, Allan; Andersen, Peter A; Buller, David B; Walkosz, Barbara; Lui, Lucia; Buller, Mary; Scott, Michael D; Jenkins, Rob

2014-01-01

Outdoor workers are especially susceptible to skin cancer--the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. Local government managers in Colorado-in municipalities, counties, and special districts-were surveyed to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. The survey consisted of 51 questions assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was composed or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. More than 40% of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant. The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting localite communities. Government size and budget do not

[Practical guidelines for the diagnosis and treatment of obstructive sleep apnea syndrome].

PubMed

Nogueira, Facundo; Nigro, Carlos; Cambursano, Hugo; Borsini, Eduardo; Silio, Julio; Avila, Jorge

2013-01-01

Obstructive sleep apnoea syndrome (OSAS) is one of the most relevant chronic respiratory pathologies due to its high prevalence and impact in morbidity and mortality. In 2001, the Asociación Argentina de Medicina Respiratoria (AAMR) published the first Argentinean Consensus on Sleep-Related breathing Disorders. Since then, wide new scientific evidence has emerged, increasing significantly the knowledge about this pathology. According to this, the Sleep-Related breathing Disorders and Oxygen Therapy Section of the AAMR, decided to update its Consensus, developing this Practical Guidelines on Management of patients with OSAS. A working group was created with members belonging to the section, experts in OSAS. They extensively reviewed the literature and wrote these guidelines, orientated to practical resolution of clinical problems and giving answers to questions emerged from dealing with patients who suffer from this syndrome. The document defines OSAS and describes the diagnosis and severity criteria, as well as the risk factors, ways of presentation and epidemiology. Clinical consequences, mainly on cognition, cardiovascular system and metabolism are pointed out. Different diagnostic methods, with their indications and technical aspects for validation and interpretation are detailed. Finally, we describe therapeutic alternatives, as well as practical aspects of their implementation. The authors' aim was to generate an accessible tool for teaching and spreading the knowledge on these disorders, which have a great impact in public health.

[Guidelines in Practice: The New S3 Guideline "Sleeping Disorders - Sleep-Related Abnormal Breathing"].

PubMed

Gerlach, Martin; Sanner, Bernd

2017-10-01

Sleep related breathing disorders include central sleep apnea (CSA), obstructive sleep apnea (OSA), sleep-related hypoventilation, and sleep-related hypoxia. These disorders are frequent and growing in clinical relevance. The related chapter of the S3 guideline "Non-restorative sleep/Sleep disorders", published by the German Sleep Society (DGSM), has recently been updated in November 2016. Epidemiology, diagnostics, therapeutic procedures, and classification of sleep related disorders have been revised. Concerning epidemiology, a considerably higher mortality rate among pregnant women with OSA has been emphasized. With regards to diagnostics, the authors point out that respiratory polygraphy may be sufficient in diagnosing OSA, if a typical clinical condition is given. For CSA, recommendations were changed to diagnose CSA with low apnea rates present. Significant changes for treating CSA in patients with left ventricular dysfunction have been introduced. In addition, there is now to be differentiated between sleep-related hypoventilation and sleep-related hypoxaemia. Obesity hypoventilation syndrome is discussed in more detail. This article sums up and comments on the published changes. Georg Thieme Verlag KG Stuttgart · New York.

[Guidelines in Practice: The New S3 Guideline "Sleeping Disorders - Sleep-Related Abnormal Breathing"].

PubMed

Gerlach, M; Sanner, B

2017-08-01

Sleep related breathing disorders include central sleep apnea (CSA), obstructive sleep apnea (OSA), sleep-related hypoventilation, and sleep-related hypoxia. These disorders are frequent and growing in clinical relevance. The related chapter of the S3 guideline "Non-restorative sleep/Sleep disorders", published by the German Sleep Society (DGSM), has recently been updated in November 2016. Epidemiology, diagnostics, therapeutic procedures, and classification of sleep related disorders have been revised. Concerning epidemiology, a considerably higher mortality rate among pregnant women with OSA has been emphasized. With regards to diagnostics, the authors point out that respiratory polygraphy may be sufficient in diagnosing OSA, if a typical clinical condition is given. For CSA, recommendations were changed to diagnose CSA with low apnea rates present. Significant changes for treating CSA in patients with left ventricular dysfunction have been introduced. In addition, there is now to be differentiated between sleep-related hypoventilation and sleep-related hypoxaemia. Obesity hypoventilation syndrome is discussed in more detail. This article sums up and comments on the published changes. © Georg Thieme Verlag KG Stuttgart · New York.

Nurses' clinical reasoning practices that support safe medication administration: An integrative review of the literature.

PubMed

Rohde, Emily; Domm, Elizabeth

2018-02-01

To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that

Effect of "this side up" T-shirts on infant sleep position.

PubMed

Barnes-Josiah, Debora L; Eurek, Paula; Huffman, Sue; Heusinkvelt, Jan; Severe-Oforah, Jennifer; Schwalberg, Renee

2007-01-01

To assess the impact of "This Side Up" T-shirts on parental practices in Nebraska. A random sample of 3,210 Nebraska women who gave birth in 2004, stratified by race/ethnicity, was mailed a brief questionnaire on their receipt of a T-shirt and SIDS risk reduction materials at their birthing hospital, and on infant sleep position. Response rates were low (25.9%), ranging from 10.6% for Native American mothers to 46.4% for White mothers. Half (52.0%) had received a T-shirt and 71.6% had received SIDS information. Two-thirds (64.0%) reported that their infants slept on their backs; African-American and Hispanic infants were significantly less likely to back sleep. In univariate logistic regression models, African-American race, Hispanic ethnicity and maternal age 30-39 were significant negative predictors of back sleeping; White race and having received a SIDS brochure were positive predictors. In the fully controlled model African American and Asian race and Hispanic ethnicity were negative predictors of back sleeping; neither receiving SIDS information nor the infant T-shirt was significant. Effects of maternal age and a SIDS informational brochure appeared in models stratified by race/ethnicity. In these data, receiving an infant T-shirt was not related to how mothers placed their infants to sleep. Additional research is needed on effective methods of delivering targeted counseling and promoting safe sleep practices among families, particularly among racial and ethnic subgroups.

Health Messaging and African-American Infant Sleep Location: A Randomized Controlled Trial.

PubMed

Moon, Rachel Y; Mathews, Anita; Joyner, Brandi L; Oden, Rosalind P; He, Jianping; McCarter, Robert

2017-02-01

Infant-parent bedsharing increases the risk of SIDS and other sleep-related deaths. Despite AAP recommendations to avoid bedsharing, public health efforts have been unsuccessful in changing behaviors. African-American infants are more than twice as likely to die from SIDS and other sleep-related deaths, and are also twice as likely to bedshare with their parents. Further, African-American parents have a high degree of self-efficacy with regards to preventing infant suffocation, but low self-efficacy with regards to SIDS risk reduction. It is unclear whether messages emphasizing suffocation prevention will decrease bedsharing. To evaluate the impact of specific health messages on African-American parental decisions regarding infant sleep location. We conducted a randomized, controlled trial of African-American mothers of infants. The control group received standard messaging emphasizing AAP-recommended safe sleep practices, including avoidance of bedsharing, for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices, including avoidance of bedsharing, for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. 1194 mothers were enrolled in the study, and 637 completed all interviews. Bedsharing, both usually (aOR 1.005 [95 % CI 1.003, 1.006]) and last night (aOR 1.004 [95 % CI 1.002, 1.007]) increased slightly but statistically significantly with infant age (p < 0.001). Receipt of the enhanced message did not impact on sleep location. Maternal belief that bedsharing increased the risk of SIDS or suffocation declined over 6 months (p < 0.001) and did not differ by group assignment. African-American mothers who received an enhanced message about SIDS risk reduction and suffocation prevention were no less likely to bedshare with their infants. Clinical Trials.gov identifier NCT01361880.

College residential sleep environment.

PubMed

Sexton-Radek, Kathy; Hartley, Andrew

2013-12-01

College students regularly report increased sleep disturbances as well as concomitant reductions in performance (e.g., academic grades) upon entering college. Sleep hygiene refers to healthy sleep practices that are commonly used as first interventions in sleep disturbances. One widely used practice of this sort involves arranging the sleep environment to minimize disturbances from excessive noise and light at bedtime. Communal sleep situations such as those in college residence halls do not easily support this intervention. Following several focus groups, a questionnaire was designed to gather self-reported information on sleep disturbances in a college population. The present study used The Young Adult Sleep Environment Inventory (YASEI) and sleep logs to investigate the sleep environment of college students living in residential halls. A summary of responses indicated that noise and light are significant sleep disturbances in these environments. Recommendations are presented related to these findings.

Breastfeeding FAQs: Sleep - Yours and Your Baby's

MedlinePlus

... Staying Safe Videos for Educators Search English Español Breastfeeding FAQs: Sleep - Yours and Your Baby's KidsHealth / For ... to sleep sooner. My baby falls asleep while nursing. What can I do? Newborns often fall asleep ...

The Relationship Between Reported Sleep Quality and Sleep Hygiene in Italian and American Adolescents

PubMed Central

LeBourgeois, Monique K.; Giannotti, Flavia; Cortesi, Flavia; Wolfson, Amy R.; Harsh, John

2014-01-01

Objective The purpose of the study was to examine the relationship between self-reported sleep quality and sleep hygiene in Italian and American adolescents and to assess whether sleep-hygiene practices mediate the relationship between culture and sleep quality. Methods Two nonprobability samples were collected from public schools in Rome, Italy, and Hattiesburg, Mississippi. Students completed the following self-report measures: Adolescent Sleep-Wake Scale, Adolescent Sleep Hygiene Scale, Pubertal Developmental Scale, and Morningness/Eveningness Scale. Results The final sample included 776 Italian and 572 American adolescents 12 to 17 years old. Italian adolescents reported much better sleep hygiene and substantially better sleep quality than American adolescents. A moderate-to-strong linear relationship was found between sleep hygiene and sleep quality in both samples. Separate hierarchical multiple regression analyses were performed on both samples. Demographic and individual characteristics explained a significant proportion of the variance in sleep quality (Italians: 18%; Americans: 25%), and the addition of sleep-hygiene domains explained significantly more variance in sleep quality (Italians: 17%; Americans: 16%). A final hierarchical multiple regression analysis with both samples combined showed that culture (Italy versus United States) only explained 0.8% of the variance in sleep quality after controlling for sleep hygiene and all other variables. Conclusions Cross-cultural differences in sleep quality, for the most part, were due to differences in sleep-hygiene practices. Sleep hygiene is an important predictor of sleep quality in Italian and American adolescents, thus supporting the implementation and evaluation of educational programs on good sleep-hygiene practices. PMID:15866860

Decisions of black parents about infant bedding and sleep surfaces: a qualitative study.

PubMed

Ajao, Taiwo I; Oden, Rosalind P; Joyner, Brandi L; Moon, Rachel Y

2011-09-01

The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted "firm sleep surface" to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a "firm" sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices.

Regular Practice of Competitive Sports Does Not Impair Sleep in Adolescents: DADOS Study.

PubMed

Beltran-Valls, María Reyes; García Artero, Enrique; Capdevila-Seder, Ana; Legaz-Arrese, Alejandro; Adelantado-Renau, Mireia; Moliner-Urdiales, Diego

2018-05-01

To analyze differences in sleep quality and duration by athletic status and sex, and to examine the association between physical activity (PA) recommendation and sleep in adolescents. A total of 267 adolescents [13.9 (0.3) y] from Deporte, ADOlescencia y Salud (DADOS) study (129 girls) were included in this cross-sectional analysis. Athletes competed regularly in organized sport events and trained ≥3 days per week, but nonathletes did not compete. PA was assessed by GENEActiv accelerometer. PA values were dichotomized into inactive (<60 min/d of moderate and vigorous PA) and active (≥60 min/d of moderate and vigorous PA). Sleep quality was evaluated with the Spanish version of the Pittsburgh Sleep Quality Index. Pittsburgh Sleep Quality Index values were dichotomized into >5 (poor quality) or ≤5 (good quality). Sleep duration was objectively measured by accelerometer. Sleep quality and duration were not statistically different between athletes [median (Mdn) = 4.0, interquartile range (IQR) = 3.0-6.0 and Mdn = 8.0, IQR = 7.4-8.6 h, respectively] and nonathletes (Mdn = 5.0, IQR = 3.0-7.0 and Mdn = 7.9; IQR = 7.3-8.6 h, respectively), P > .05. Nonathlete or inactive adolescents did not show higher risk for poor sleep quality or short sleep duration than athletes [odds ratio (OR) = 1.17; 95% confidence interval (CI), 0.68-2.00 and OR = 0.93; 95% CI, 0.56-1.55, respectively] or active peers (OR = 1.39; 95% CI, 0.66-2.89 and OR = 1.62; 95% CI, 0.78-3.37, respectively). In our group of adolescents, competitive sport practice did not alter sleep patterns. PA recommendations for adolescents may not discriminate between good and poor sleepers.

Sleep. 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome.

PubMed

George, C F P

2004-09-01

Driving is a complex task involving distinct cognitive, perceptual, motor, and decision making skills. After placing the vehicle on the road, the driver must constantly survey the ever changing roadway environment to keep the vehicle in the lane and moving at an appropriate safe speed. This surveillance involves two distinct visual tasks: estimating and responding to the oncoming curvature and controlling lane position. Driving is therefore a divided attention task involving speed and lane control as well as monitoring. To do this in a safe manner requires careful attention and alertness which can be problematic for patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or other sleep disorders.

Circadian Rhythm Sleep Disorders: Part II, Advanced Sleep Phase Disorder, Delayed Sleep Phase Disorder, Free-Running Disorder, and Irregular Sleep-Wake Rhythm

PubMed Central

Sack, Robert L; Auckley, Dennis; Auger, R. Robert; Carskadon, Mary A.; Wright, Kenneth P.; Vitiello, Michael V.; Zhdanova, Irina V.

2007-01-01

Objective: This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disorder (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR). Methods: A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. Results: A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of CRSDs. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting (“resetting the clock”), and 3) symptomatic treatment using hypnotic and stimulant medications. Conclusion: Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria. Citation: Sack R; Auckley D; Auger RR; Carskadon MA; Wright KP; Vitiello MV; Zhdanova IV. Circadian rhythm sleep disorders: Part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. SLEEP 2007;30(11):1484-1501. PMID:18041481

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Trends in infant bedding use: National Infant Sleep Position study, 1993-2010.

PubMed

Shapiro-Mendoza, Carrie K; Colson, Eve R; Willinger, Marian; Rybin, Denis V; Camperlengo, Lena; Corwin, Michael J

2015-01-01

Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown. To investigate the US prevalence of and trends in bedding use, we analyzed 1993-2010 data from the National Infant Sleep Position study. Infants reported as being usually placed to sleep with blankets, quilts, pillows, and other similar materials under or covering them in the last 2 weeks were classified as bedding users. Logistic regression was used to describe characteristics associated with bedding use. From 1993 to 2010, bedding use declined but remained a widespread practice (moving average of 85.9% in 1993-1995 to 54.7% in 2008-2010). Prevalence was highest for infants of teen-aged mothers (83.5%) and lowest for infants born at term (55.6%). Bedding use was also frequently reported among infants sleeping in adult beds, on their sides, and on a shared surface. The rate of decline in bedding use was markedly less from 2001-2010 compared with 1993-2000. For 2007 to 2010, the strongest predictors (adjusted odds ratio: ≥1.5) of bedding use were young maternal age, non-white race and ethnicity, and not being college educated. Bedding use for infant sleep remains common despite recommendations against this practice. Understanding trends in bedding use is important for tailoring safe sleep interventions. Copyright © 2015 by the American Academy of Pediatrics.

Safe delivery and newborn care practices in Sindh, Pakistan: a community-based investigation of mothers and health workers.

PubMed

Hassan, Hamid; Jokhio, Abdul Hakeem; Winter, Heather; Macarthur, Christine

2012-08-01

to determine the prevalence of specific intrapartum practices in Sindh province, Pakistan. a cross-sectional, questionnaire based study. 6 health clinics in Mirpurkhas, Sindh province, rural Pakistan. 225 mothers and 82 health workers. outcome measures were indicators of safe delivery practices and referral following an obstetric complication. Prevalence of unhygienic and unsafe practices in deliveries attended by Traditional Birth Attendants (TBAs) was common. Deliveries by skilled attendants were significantly safer but with some failures in hygienic practices. 29% of women who had experienced an obstetric complication had not received emergency obstetric care. safe delivery practices and newborn care needs to be improved in rural Pakistan. This may be achieved by training health workers and TBAs in safe delivery practices, using safe delivery kits and with an effective referral system. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Standardized Shift Handover Protocol: Improving Nurses’ Safe Practice in Intensive Care Units

PubMed Central

Malekzadeh, Javad; Mazluom, Seyed Reza; Etezadi, Toktam; Tasseri, Alireza

2013-01-01

Introduction: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. Methods: In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses’ Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. Results: Study findings revealed that nurses’ mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7) to 17.0 (1.8) (P < 0.001). Conclusion: using a standard handover protocol for communicating patient’s needs and information improves nurses’ safe practice in the area of basic nursing care. PMID:25276725

Daily Sleep Patterns, Sleep Quality, and Sleep Hygiene Among Parent–Child Dyads of Young Children Newly Diagnosed With Juvenile Idiopathic Arthritis and Typically Developing Children

PubMed Central

Chen, Maida Lynn; Cain, Kevin C.; Ringold, Sarah; Wallace, Carol A.; Ward, Teresa M.

2016-01-01

Objectives Describe daily sleep patterns, sleep quality, and sleep hygiene in 2–5-year-old children newly diagnosed with juvenile idiopathic arthritis (JIA) and their parents in comparison with typically developing (TD) children and parents. Methods Participants (13 JIA, 16 TD parent–child dyads) wore actigraphs for 10 days. Parents completed sleep diaries and sleep hygiene survey. Results Children with JIA had significantly less total sleep time, lower sleep efficiency (SE), and longer naps than TD children. Parents of children with JIA had significantly earlier bedtimes, more wake after sleep onset (WASO) and lower SE than TD parents. Parent–child SE and WASO were interrelated in JIA dyads. Sleep hygiene practices were inconsistent in both groups of children. Conclusions Inadequate amounts of sleep and poor sleep quality were common in parent–child dyads. Early interventions to improve sleep duration and promote sleep hygiene practices may alleviate future sleep problems and improve parent and child well-being. PMID:26994855

Consumer Sleep Technology: An American Academy of Sleep Medicine Position Statement.

PubMed

Khosla, Seema; Deak, Maryann C; Gault, Dominic; Goldstein, Cathy A; Hwang, Dennis; Kwon, Younghoon; O'Hearn, Daniel; Schutte-Rodin, Sharon; Yurcheshen, Michael; Rosen, Ilene M; Kirsch, Douglas B; Chervin, Ronald D; Carden, Kelly A; Ramar, Kannan; Aurora, R Nisha; Kristo, David A; Malhotra, Raman K; Martin, Jennifer L; Olson, Eric J; Rosen, Carol L; Rowley, James A

2018-05-15

Consumer sleep technologies (CSTs) are widespread applications and devices that purport to measure and even improve sleep. Sleep clinicians may frequently encounter CST in practice and, despite lack of validation against gold standard polysomnography, familiarity with these devices has become a patient expectation. This American Academy of Sleep Medicine position statement details the disadvantages and potential benefits of CSTs and provides guidance when approaching patient-generated health data from CSTs in a clinical setting. Given the lack of validation and United States Food and Drug Administration (FDA) clearance, CSTs cannot be utilized for the diagnosis and/or treatment of sleep disorders at this time. However, CSTs may be utilized to enhance the patient-clinician interaction when presented in the context of an appropriate clinical evaluation. The ubiquitous nature of CSTs may further sleep research and practice. However, future validation, access to raw data and algorithms, and FDA oversight are needed. © 2018 American Academy of Sleep Medicine.

Exploring varieties of knowledge in safe work practices - an ethnographic study of surgical teams

PubMed Central

2011-01-01

Background Within existing research in health and medicine, the nature of knowledge on how teams conduct safe work practices has yet to be properly explored. Methods We address this concern by exploring the varieties in which knowledge is expressed during interdisciplinary surgical operations. Specifically, the study was conducted in a surgical section of a Norwegian regional general hospital, between January and April of 2010, by means of an ethnographic design combining detailed non-participant observations, conversations and semi-structured interviews. Results Based on an analysis of the gathered data, we identify three particular themes in how knowledge is expressed by operating room personnel: (i) the ability and variety individuals demonstrate in handling multiple sources of information, before reaching a particular decision, (ii) the variety of ways awareness or anticipation of future events is expressed, and (iii) the different ways sudden and unexpected situations are handled by the individual team members. Conclusions We conclude that these facets of knowledge bring different insights into how safe work practices are achieved at an individual and team level in surgical operations, thus adding to the existing understanding of the nature of knowledge in safe work practices in surgical operations. Future research should focus on exploring and documenting the relationships between various elements of knowledge and safe work practices, in different surgical settings and countries. PMID:21914183

Sleep disturbances in patients with major depressive disorder: incongruence between sleep log and actigraphy.

PubMed

Kung, Pei-Ying; Chou, Kuei-Ru; Lin, Kuan-Chia; Hsu, Hsin-Wei; Chung, Min-Huey

2015-02-01

Depression has become a severe global health problem, and sleeping difficulties are typically associated with depression. The purpose of this study was to investigate the relationships among subjective sleep quality, objective sleep quality, and the sleep hygiene practices of hospitalized patients with major depressive disorder. Daily sleep logs and actigraphy were used to obtain subjective and objective sleep data. Thirty patients were recruited from a regional teaching hospital in Taipei and completed the Hamilton Rating Scale for Depression and the Sleep Hygiene Practice Scale. Significant differences were found between subjective and objective sleep data in patients with major depressive disorder (MDD). For patients with more severe depression, subjective measurements obtained using sleep logs, such as total sleep time and sleep efficiency, were significantly lower than those obtained using actigraphy by controlling for demographics. The results regarding the differences between subjective and objective sleep data can be a reference for care providers when comforting depression patients who complain of sleep disturbance. Copyright © 2014 Elsevier Inc. All rights reserved.

Hypertension with unsatisfactory sleep health (HUSH): study protocol for a randomized controlled trial.

PubMed

Levenson, Jessica C; Rollman, Bruce L; Ritterband, Lee M; Strollo, Patrick J; Smith, Kenneth J; Yabes, Jonathan G; Moore, Charity G; Harvey, Allison G; Buysse, Daniel J

2017-06-06

Insomnia is common in primary care medical practices. Although behavioral treatments for insomnia are safe, efficacious, and recommended in practice guidelines, they are not widely-available, and their effects on comorbid medical conditions remain uncertain. We are conducting a pragmatic clinical trial to test the efficacy of two cognitive behavioral treatments for insomnia (Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi)) versus an enhanced usual care condition (EUC). The study is a three-arm, parallel group, randomized controlled trial. Participants include 625 adults with hypertension and insomnia, recruited via electronic health records from primary care practices affiliated with a large academic medical center. After screening and baseline assessments, participants are randomized to treatment. BBTI is delivered individually with a live therapist via web-interface/telehealth sessions, while SHUTi is a self-guided, automated, interactive, web-based form of cognitive behavioral therapy for insomnia. Participants in EUC receive an individualized sleep report, educational resources, and an online educational video. Treatment outcomes are measured at 9 weeks, 6 months, and 12 months. The primary outcome is patient-reported sleep disturbances. Secondary outcomes include other self-reported sleep measures, home blood pressure, body mass index, quality of life, health functioning, healthcare utilization, and side effects. This randomized clinical trial compares two efficacious insomnia interventions to EUC, and provides a cost-effective and efficient examination of their similarities and differences. The pragmatic orientation of this trial may impact sleep treatment delivery in real world clinical settings and advance the dissemination and implementation of behavioral sleep interventions. ClinicalTrials.gov (Identifier: NCT02508129 ; Date Registered: July 21, 2015).

Sleep and your health

MedlinePlus

... Practice of Sleep Medicine . 6th ed. Philadelphia, PA: Elsevier; 2017:chap 2. Centers for Disease Control and ... Practice of Sleep Medicine . 6th ed. Philadelphia, PA: Elsevier; 2017:chap 75. Philip P, Sagaspe P, Taillard ...

Sleep Variability, Health-Related Practices and Inflammatory Markers in a Community Dwelling Sample of Older Adults

PubMed Central

Okun, Michele L.; Reynolds, Charles F.; Buysse, Daniel J.; Monk, Timothy H; Mazumdar, Sati; Begley, Amy; Hall, Martica

2011-01-01

Background Low-grade chronic inflammation is an important risk factor for age-related morbidity. Health behaviors, including average aggregate measures of sleep, have been linked to increased inflammation in older adults. Variability in sleep timing may also be associated with increased inflammation. This study evaluated relationships among several health behaviors and circulating proinflammatory cytokines (IL-6 and TNF-α). Method Participants were community dwelling older adults >60 years (N = 222: 39 bereaved, 55 caregivers, 52 with insomnia, and 76 good sleepers). Mean values and intra-individual variability in sleep, as well as caffeine and alcohol use, exercise, and daytime napping were assessed by sleep diaries. Blood draws were obtained in the morning. Results Several interactions were noted between sleep behaviors, inflammatory markers, and participant group. Greater variability in wake time and time in bed was associated with higher IL-6 among good sleepers relative to caregivers and older adults with insomnia. Good sleepers who consumed moderate amounts of alcohol had the lowest concentrations of IL-6 compared to the other three groups who consumed alcohol. Insomnia subjects, but not good sleepers, showed increased concentrations of IL-6 associated with caffeine use. Caregivers showed increased concentrations of TNF-α with alcohol use relative to good sleepers. Greater variability in bedtime, later wake times and longer time in bed was associated with higher TNF-α regardless of group. Conclusions Moderation and regularity in the practice of certain health behaviors, including sleep practices, were associated with lower plasma levels of inflammatory markers in older adults. Life circumstances and specific sleep disorders may modify these associations. PMID:21097658

Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

PubMed Central

Ajao, Taiwo I.; Oden, Rosalind P.; Joyner, Brandi L.

2011-01-01

OBJECTIVE: The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. METHODS: We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. RESULTS: Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted “firm sleep surface” to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. CONCLUSIONS: Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a “firm” sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices. PMID:21859921

Trends in Infant Bedding Use: National Infant Sleep Position Study, 1993–2010

PubMed Central

Colson, Eve R.; Willinger, Marian; Rybin, Denis V.; Camperlengo, Lena; Corwin, Michael J.

2015-01-01

BACKGROUND: Use of potentially hazardous bedding, as defined by the American Academy of Pediatrics (eg, pillows, quilts, comforters, loose bedding), is a modifiable risk factor for sudden infant death syndrome and unintentional sleep-related suffocation. The proportion of US infants sleeping with these types of bedding is unknown. METHODS: To investigate the US prevalence of and trends in bedding use, we analyzed 1993–2010 data from the National Infant Sleep Position study. Infants reported as being usually placed to sleep with blankets, quilts, pillows, and other similar materials under or covering them in the last 2 weeks were classified as bedding users. Logistic regression was used to describe characteristics associated with bedding use. RESULTS: From 1993 to 2010, bedding use declined but remained a widespread practice (moving average of 85.9% in 1993–1995 to 54.7% in 2008–2010). Prevalence was highest for infants of teen-aged mothers (83.5%) and lowest for infants born at term (55.6%). Bedding use was also frequently reported among infants sleeping in adult beds, on their sides, and on a shared surface. The rate of decline in bedding use was markedly less from 2001–2010 compared with 1993–2000. For 2007 to 2010, the strongest predictors (adjusted odds ratio: ≥1.5) of bedding use were young maternal age, non-white race and ethnicity, and not being college educated. CONCLUSIONS: Bedding use for infant sleep remains common despite recommendations against this practice. Understanding trends in bedding use is important for tailoring safe sleep interventions. PMID:25452654

Sleep Disorders: Insomnia.

PubMed

Burman, Deepa

2017-09-01

Insomnia is the most common type of sleep disorder in the family medicine population. It is defined as a persistent difficulty initiating or maintaining sleep, or a report of nonrestorative sleep, accompanied by related daytime impairment. Insomnia is a significant public health problem because of its high prevalence and management challenges. There is increasing evidence of a strong association between insomnia and various medical and psychiatric comorbidities. Diagnosis of insomnia and treatment planning rely on a thorough sleep history to address contributing and precipitating factors as well as maladaptive behaviors resulting in poor sleep. Using a sleep diary or sleep log is more accurate than patient recall to determine sleep patterns. A sleep study is not routinely indicated for evaluation of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the mainstay of treatment and is a safe and effective approach. The key challenge of CBT-I is the lack of clinicians to implement it. The newer generation nonbenzodiazepines (eg, zolpidem, zaleplon) are used as first-line pharmacotherapy for chronic insomnia. Newer drugs active on targets other than the gamma-aminobutyric acid receptor are now available, but clear treatment guidelines are needed. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

American Academy of Dental Sleep Medicine

MedlinePlus

... Coverage New Research AADSM Highlights Members More news... Dental Sleep Medicine: An area of dental practice that focuses on the use of oral ... News RSS Links Find A Dentist Platinum Sponsors Dental Sleep Solutions Nierman Practice Management ProSomnus Sleep Technologies ...

Sleep in Children with Autism Spectrum Disorder

PubMed Central

Zavodny, Stefanie; Eriksen, Whitney; Sinko, Rebecca; Connell, James; Kerns, Connor; Schaaf, Roseann; Pinto-Martin, Jennifer

2018-01-01

The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD. PMID:28502070

Sleep in Children with Autism Spectrum Disorder.

PubMed

Souders, Margaret C; Zavodny, Stefanie; Eriksen, Whitney; Sinko, Rebecca; Connell, James; Kerns, Connor; Schaaf, Roseann; Pinto-Martin, Jennifer

2017-06-01

The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD.

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study

PubMed Central

Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

2017-01-01

Introduction Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. Methods This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. Ethics and dissemination This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. PMID:28132001

Adoption of Sun Safe Work Place Practices by Local Governments

PubMed Central

Wallis, Allan; Andersen, Peter A.; Buller, David B.; Walkosz, Barbara; Lui, Lucia; Buller, Mary; Scott, Michael D.; Jenkins, Rob

2014-01-01

Context Outdoor workers are especially susceptible to skin cancer, the most common, but also one of the most preventable, forms of cancer. Colorado, the location of the study, has the second highest rate of skin cancer deaths in the nation. Objective Local government managers in Colorado—in municipalities, counties and special districts—were surveyed in order to ascertain the extent to which they engage in formal (written) and informal practices to protect their outdoor workers against excessive exposure to sun. Design The survey consisted of 51 question assessing awareness of formal or informal practices for sun protection of outdoor workers. An index of practices--the study's dependent variable--was created that was comprised or practices such as providing employees free or reduced-cost sunscreen, wide-brimmed hats, sunglasses, long-sleeved work shirts, long work pants, and temporary or permanent outdoor shade shelters. Proscriptive policies, such as restricting the use of broad brimmed hats, were subtracted from the index. Surveys were completed by 825 administrators representing 98 jurisdictions. Responses from administrators in the same jurisdiction were averaged. Results Over 40 percent of responding jurisdictions indicated that they engaged in informal sun safety practices. Tests conducted to determine what variables might account for the adoption of these sun protection practices found that the degree to which a community could be regarded as cosmopolite and as having an individualistic political culture were significant predictors. Type of government was also significant. Although, higher community income was a significant predictor, neither local government budget nor size was significant. Conclusions The adoption of sun safe practices bears low costs with potentially high returns. Findings from this study suggest that awareness campaigns might most effectively target cosmopolite communities, but that the greatest impact might be achieved by targeting

Sleep Issues and Sundowning

MedlinePlus

... Medicaid Tax Deductions & Credits Planning Ahead for Legal Matters Legal Documents Health Care Reform Resources Ethical & Care ... reduce the agitation that occurs when surroundings are dark or unfamiliar. Make a comfortable and safe sleep ...

Sleep: An Expanding Field of Practice and Research.

ERIC Educational Resources Information Center

Piccione, Paul M.; Barth, Richard P.

1983-01-01

Summarizes recent advances in the knowledge and treatment of sleep disorders and examines the interaction of sleep with social work concerns such as aging, depression, sexual dysfunction, alcoholism, and anxiety. Social workers' awareness of the diagnostic signs for sleep disorders and available interventions will improve client care. (JAC)

Safe clinical practice for patients hospitalised in a suicidal crisis: a study protocol for a qualitative case study.

PubMed

Berg, Siv Hilde; Rørtveit, Kristine; Walby, Fredrik A; Aase, Karina

2017-01-27

Suicide prevention in psychiatric care is arguably complex and incompletely understood as a patient safety issue. A resilient healthcare approach provides perspectives through which to understand this complexity by understanding everyday clinical practice. By including suicidal patients and healthcare professionals as sources of knowledge, a deeper understanding of what constitutes safe clinical practice can be achieved. This planned study aims to adopt the perspective of resilient healthcare to provide a deeper understanding of safe clinical practice for suicidal patients in psychiatric inpatient care. It will describe the experienced components and conditions of safe clinical practice and the experienced practice of patient safety. The study will apply a descriptive case study approach consisting of qualitative semistructured interviews and focus groups. The data sources are hospitalised patients in a suicidal crisis and healthcare professionals in clinical practice. This study was approved by the Regional Ethics Committee (2016/34). The results will be disseminated through scientific articles, a PhD dissertation, and national and international conferences. These findings can generate knowledge to be integrated into the practice of safety for suicidal inpatients in Norway and to improve the feasibility of patient safety measures. Theoretical generalisations can be drawn regarding safe clinical practice by taking into account the experiences of patients and healthcare professionals. Thus, this study can inform the conceptual development of safe clinical practice for suicidal patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Advanced Practice Registered Nurses and Physician Assistants in Sleep Centers and Clinics: A Survey of Current Roles and Educational Background

PubMed Central

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.

2014-01-01

Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545

Clinical Practice Guideline: Safe Medication Use in the ICU.

PubMed

Kane-Gill, Sandra L; Dasta, Joseph F; Buckley, Mitchell S; Devabhakthuni, Sandeep; Liu, Michael; Cohen, Henry; George, Elisabeth L; Pohlman, Anne S; Agarwal, Swati; Henneman, Elizabeth A; Bejian, Sharon M; Berenholtz, Sean M; Pepin, Jodie L; Scanlon, Mathew C; Smith, Brian S

2017-09-01

To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed

Reliability of the American Academy of Sleep Medicine Rules for Assessing Sleep Depth in Clinical Practice.

PubMed

Younes, Magdy; Kuna, Samuel T; Pack, Allan I; Walsh, James K; Kushida, Clete A; Staley, Bethany; Pien, Grace W

2018-02-15

The American Academy of Sleep Medicine has published manuals for scoring polysomnograms that recommend time spent in non-rapid eye movement sleep stages (stage N1, N2, and N3 sleep) be reported. Given the well-established large interrater variability in scoring stage N1 and N3 sleep, we determined the range of time in stage N1 and N3 sleep scored by a large number of technologists when compared to reasonably estimated true values. Polysomnograms of 70 females were scored by 10 highly trained sleep technologists, two each from five different academic sleep laboratories. Range and confidence interval (CI = difference between the 5th and 95th percentiles) of the 10 times spent in stage N1 and N3 sleep assigned in each polysomnogram were determined. Average values of times spent in stage N1 and N3 sleep generated by the 10 technologists in each polysomnogram were considered representative of the true values for the individual polysomnogram. Accuracy of different technologists in estimating delta wave duration was determined by comparing their scores to digitally determined durations. The CI range of the ten N1 scores was 4 to 39 percent of total sleep time (% TST) in different polysomnograms (mean CI ± standard deviation = 11.1 ± 7.1 % TST). Corresponding range for N3 was 1 to 28 % TST (14.4 ± 6.1 % TST). For stage N1 and N3 sleep, very low or very high values were reported for virtually all polysomnograms by different technologists. Technologists varied widely in their assignment of stage N3 sleep, scoring that stage when the digitally determined time of delta waves ranged from 3 to 17 seconds. Manual scoring of non-rapid eye movement sleep stages is highly unreliable among highly trained, experienced technologists. Measures of sleep continuity and depth that are reliable and clinically relevant should be a focus of clinical research. © 2018 American Academy of Sleep Medicine

Sleep, the Athlete, and Performance.

ERIC Educational Resources Information Center

Walters, Peter Hudson

2002-01-01

Presents information to help athletic coaches and trainers gain a better understanding of what happens during sleep and how sleep can affect performance, outlining three practical suggestions for helping athletes improve their sleep quality (identify and obtain the amount of sleep one needs, keep a regular sleep schedule, and create an optimal…

Demographic and Parenting Correlates of Adolescent Sleep Functioning.

PubMed

Zapata Roblyer, Martha I; Grzywacz, Joseph G

2015-11-01

Despite the importance of parenting practices for adolescent adjustment, parenting correlates of adolescent sleep functioning remain understudied. This study delineated patterns of sleep functioning in a sample of ethnically diverse, low-income, adolescents and examined associations among three types of parenting practices (parental involvement, parent-child conflict, and parental control) and adolescent sleep functioning (difficulties initiating sleep and maintaining sleep, and sleep duration). Adolescents ( N = 91, 11-19 years old) self-reported on sleep functioning and parenting practices. Results showed that in the preceding month, 60.5% of adolescents had difficulties initiating sleep and 73.6% had difficulties maintaining sleep. Most adolescents slept 8 or more hours per night, but 30.7% slept less than 8 hours. Latino adolescents slept longer and had fewer difficulties maintaining sleep than non-Latino. High school students had fewer difficulties maintaining sleep than their middle school counterparts; conversely, older adolescents experienced shorter sleep duration than younger ones. Adolescents whose parents had post-secondary education had shorter sleep duration than those whose parents had not graduated from high school. Parental control was correlated with fewer difficulties initiating sleep, whereas parent-child conflict was correlated with more difficulties maintaining sleep. There were no parenting correlates of sleep duration. Latino adolescents had better sleep profiles than non-Latino ones. Regression analyses showed that parental control and parent-child conflict were associated with adolescent sleep functioning across ethnicities. Results suggest that parenting practices, as well as demographic characteristics, are associated with adolescent sleep functioning and should be taken into account in interventions aimed at improving sleep functioning among adolescents.

Sleeping while disabled, disabled while sleeping.

PubMed

Reiss, Benjamin

2016-09-01

This essay considers areas in which the study of sleep and sleep disorders might profit from the perspective of disability studies, as practiced in the humanities and social sciences. This interdisciplinary perspective considers the social and cultural dimensions of bodily and mental states and conditions that a particular society deems abnormal or impaired, as well as the lived consequences of those determinations. Some sleep disorders are considered disabilities, but almost all disabilities entail some disruption from normal sleeping patterns--whether because of physical pain, exhaustion, and emotional stress of facing obstacles in work and other areas of waking life, or challenging sleeping environments in which many disabled people live. Despite these disruptions, finding adequate nighttime care is often difficult for people with disabilities, and consequently, night is often when social isolation and vulnerability are most profound. In addition, caretakers themselves often find their own sleep profoundly disrupted, whether this occurs in a family setting or an institutional space. Finally, the essay suggests that a disability studies perspective can help us to see that disordered sleep--whether primary or secondary to a disabling condition--can both impact and be shaped by social relationships. Copyright © 2016 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Picture Me Safe

ERIC Educational Resources Information Center

Irvin, Daniel W.

1977-01-01

The validity of well-written articles can be destroyed by poor illustration, especially when the pictures show unsafe practices. The responsibility lies with the author to provide clear printable pictures showing safe working environments and safe practices. (Editor)

Practice Parameters for the Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults

PubMed Central

Aurora, R. Nisha; Casey, Kenneth R.; Kristo, David; Auerbach, Sanford; Bista, Sabin R.; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I.

2010-01-01

Background: Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP),radiofrequency ablation (RFA), and palatal implants. Recommendations: The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive

The use of collaboration to implement evidence-based safe practices.

PubMed

Clarke, John R

2013-12-01

The Pennsylvania Patient Safety Authority receives over 235,000 reports of medical error per year. Near miss and serious event reports of common and interesting problems are analysed to identify best practices for preventing harmful errors. Dissemination of this evidence-based information in the peer-reviewed Pennsylvania Patient Safety Advisory and presentations to medical staffs are not sufficient for adoption of best practices. Adoption of best practices has required working with institutions to identify local barriers to and incentives for adopting best practices and redesigning the delivery system to make desired behaviour easy and undesirable behaviour more difficult. Collaborations, where institutions can learn from the experiences of others, have show decreases in harmful events. The Pennsylvania Program to Prevent Wrong-Site Surgery is used as an example. Two collaborations to prevent wrong-site surgery have been completed, one with 30 institutions in eastern Pennsylvania and one with 19 in western Pennsylvania. The first collaboration achieved a 73% decrease in the rolling average of wrong-site events over 18 months. The second collaboration experienced no wrong-site operating room procedures over more than one year. Significance for public healthSince the Institute of Medicine's To Err is Human identified medical errors as a major cause of death, the public has been interested in the recommendations for reporting of medical errors and implementing safe systems for the delivery of healthcare. The Commonwealth of Pennsylvania has followed those recommendations and found that an essential intermediate step between analysing reports and implementing safe systems is collaborative learning among healthcare institutions. The experience in Pennsylvania should be useful to other public organizations wishing to improve safety.

What Is REM Sleep

MedlinePlus

... YouTube follow us on Flickr follow us on Instagram Español NICHD Theme Browse AZTopics Browse A-Z ... Publications Sitemap Español facebook twitter pinterest youtube flickr Instagram NEWSROOM NICHD News Videos OUTREACH Safe to Sleep® ...

Sleep Medicine in Saudi Arabia.

PubMed

Almeneessier, Aljohara S; BaHammam, Ahmed S

2017-04-15

The practice of sleep medicine in Saudi Arabia began in the mid to late 1990s. Since its establishment, this specialty has grown, and the number of specialists has increased. Based on the available data, sleep disorders are prevalent among the Saudi population, and the demand for sleep medicine services is expected to increase significantly. Currently, two training programs are providing structured training and certification in sleep medicine in this country. Recently, clear guidelines for accrediting sleep medicine specialists and technologists were approved. Nevertheless, numerous obstacles hamper the progress of this specialty, including the lack of trained technicians, specialists, and funding. Increasing the awareness of sleep disorders and their serious consequences among health care workers, health care authorities, and insurance companies is another challenge. Future plans should address the medical educational system at all levels to demonstrate the importance of early detection and the treatment of sleep disorders. This review discusses the current position of and barriers to sleep medicine practice and education in Saudi Arabia. © 2017 American Academy of Sleep Medicine

How much is left in your "sleep tank"? Proof of concept for a simple model for sleep history feedback.

PubMed

Dorrian, Jillian; Hursh, Steven; Waggoner, Lauren; Grant, Crystal; Pajcin, Maja; Gupta, Charlotte; Coates, Alison; Kennaway, David; Wittert, Gary; Heilbronn, Leonie; Vedova, Chris Della; Banks, Siobhan

2018-02-02

Technology-supported methods for sleep recording are becoming increasingly affordable. Sleep history feedback may help with fatigue-related decision making - Should I drive? Am I fit for work? This study examines a "sleep tank" model (SleepTank ™ ), which is analogous to the fuel tank in a car, refilled by sleep, and depleted during wake. Required inputs are sleep period time and sleep efficiency (provided by many consumer-grade actigraphs). Outputs include suggested hours remaining to "get sleep" and percentage remaining in tank (Tank%). Initial proof of concept analyses were conducted using data from a laboratory-based simulated nightshift study. Ten, healthy males (18-35y) undertook an 8h baseline sleep opportunity and daytime performance testing (BL), followed by four simulated nightshifts (2000 h-0600 h), with daytime sleep opportunities (1000 h-1600 h), then an 8 h night-time sleep opportunity to return to daytime schedule (RTDS), followed by daytime performance testing. Psychomotor Vigilance Task (PVT) and Karolinska Sleepiness Scale were performed at 1200 h on BL and RTDS, and at 1830 h, 2130 h 0000 h and 0400 h each nightshift. A 40-minute York Driving Simulation was performed at 1730 h, 2030 h and 0300 h on each nightshift. Model outputs were calculated using sleep period timing and sleep efficiency (from polysomnography) for each participant. Tank% was a significant predictor of PVT lapses (p < 0.001), and KSS (p < 0.001), such that every 5% reduction resulted in an increase of two lapses, or one point on the KSS. Tank% was also a significant predictor of %time in the Safe Zone from the driving simulator (p = 0.001), such that every 1% increase in the tank resulted in a 0.75% increase in time spent in the Safe Zone. Initial examination of the correspondence between model predictions and performance and sleepiness measures indicated relatively good predictive value. Results provide tentative evidence that this

Sleep Medicine in Saudi Arabia

PubMed Central

Almeneessier, Aljohara S.; BaHammam, Ahmed S.

2017-01-01

The practice of sleep medicine in Saudi Arabia began in the mid to late 1990s. Since its establishment, this specialty has grown, and the number of specialists has increased. Based on the available data, sleep disorders are prevalent among the Saudi population, and the demand for sleep medicine services is expected to increase significantly. Currently, two training programs are providing structured training and certification in sleep medicine in this country. Recently, clear guidelines for accrediting sleep medicine specialists and technologists were approved. Nevertheless, numerous obstacles hamper the progress of this specialty, including the lack of trained technicians, specialists, and funding. Increasing the awareness of sleep disorders and their serious consequences among health care workers, health care authorities, and insurance companies is another challenge. Future plans should address the medical educational system at all levels to demonstrate the importance of early detection and the treatment of sleep disorders. This review discusses the current position of and barriers to sleep medicine practice and education in Saudi Arabia. Citation: Almeneessier AS, BaHammam AS. Sleep medicine in Saudi Arabia. J Clin Sleep Med. 2017;13(4):641–645. PMID:28212693

Characteristics of Infant Deaths during Sleep While Under Nonparental Supervision.

PubMed

Lagon, Elena; Moon, Rachel Y; Colvin, Jeffrey D

2018-03-28

To compare risk factors for infant sleep-related deaths under the supervision of parents and nonparents. We conducted a secondary analysis of sleep-related infant deaths from 2004 to 2014 in the National Center for Fatality Review and Prevention Child Death Review Case Reporting System. The main exposure was supervisor at time of death. Primary outcomes included sleep position, location, and objects in the environment. Risk factors for parental vs nonparental supervisor were compared using χ 2 and multivariable logistic regression models. Risk factors associated with different nonparental supervisors were analyzed using χ 2 . Of the 10 490 deaths, 1375 (13.1%) occurred under nonparental supervision. Infants who died under nonparental supervision had higher adjusted odds of dying outside the home (OR 12.87, 95% CI 11.31-14.65), being placed prone (OR 1.61, 95% CI 1.39-1.86) or on their side (OR 1.35, 95% CI 1.12-1.62), or being found prone (OR 1.74, 95% CI 1.50-2.02). Among infants who died under nonparental supervision, those supervised by relatives or friends were more often placed on an adult bed or couch for sleep and bed sharing (P < .0001), and to have objects in the sleep environment (P = .01). Infants who died of sleep-related causes under nonparental supervision were more likely to have been placed nonsupine. Among nonparental supervisors, relatives and friends were more likely to use unsafe sleep environments, such as locations other than a crib or bassinet and bed sharing. Pediatricians should educate parents that all caregivers must always follow safe sleep practices. Copyright © 2018 Elsevier Inc. All rights reserved.

Physical neighborhood and social environment, beliefs about sleep, sleep hygiene behaviors, and sleep quality among African Americans.

PubMed

Nam, Soohyun; Whittemore, Robin; Jung, Sunyoung; Latkin, Carl; Kershaw, Trace; Redeker, Nancy S

2018-06-01

African Americans (AAs) have a higher prevalence of sleep disorders than other racial/ethnic groups. However, little is known about the relationships among individual and neighborhood factors related to sleep quality in AAs. The purposes of this study were to (1) describe beliefs about sleep, sleep hygiene behaviors, and sleep quality among AAs; and (2) examine the relationships among sociodemographic characteristics, neighborhood environment, beliefs about sleep, sleep hygiene behaviors, and sleep quality. We conducted a cross-sectional study of 252 AA men and women in the Greater New Haven, CT, USA community. We assessed their sociodemographic characteristics, neighborhood environment, beliefs about sleep, sleep hygiene, and sleep quality with the following measures, respectively: the Neighborhood Environment Scale, the brief version of Dysfunctional Beliefs and Attitudes about Sleep, the Sleep Hygiene Practice Scale, the Pittsburgh Sleep Quality Index. We performed descriptive statistics, correlations and multiple hierarchical regression. About 72% of the participants (mean age: 53.88 ± 14.17 years, 77.8% women) reported experiencing sleep disturbance. People with poor sleep quality were more likely to report poorer neighborhood social environment (social cohesion), poorer overall neighborhood environment, more dysfunctional beliefs toward sleep, and poorer sleep hygiene than those who had good sleep quality. In the final multivariate model that controlled for a number of chronic comorbid conditions, neighborhood environment, beliefs about sleep, and sleep hygiene behaviors were significantly associated with sleep quality. Future efforts are needed to improve sleep among AAs by considering both the individual's belief about sleep, sleep hygiene behaviors and neighborhood factors. Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Interaction between HIV awareness, knowledge, safe sex practice and HIV prevalence: evidence from Botswana.

PubMed

Ray, Ranjan; Sinha, Kompal

2012-05-01

This paper makes methodological and empirical contributions to the study of HIV in the context of Botswana, a country with high HIV prevalence. Comparable evidence is presented from India to put the Botswana results in perspective. The results point to the strong role played by affluence and education in increasing HIV knowledge, promoting safe sex and reducing HIV prevalence. The study presents African evidence on the role played by the empowerment of women in promoting safe sex practices such as condom use. The lack of significant association between HIV prevalence and safe sex practice points to the danger of HIV-infected individuals spreading the disease through multiple sex partners and unprotected sex. This danger is underlined by the finding that females with multiple sex partners are at higher risk of being infected with HIV. These results take on special policy significance in the context of Botswana, where the issue of multiple sex partners has not been adequately addressed in the programme to contain the spread of HIV.

Obstructive sleep apnea - adults

MedlinePlus

... SM. Obstructive sleep apnea: clinical features, evaluation, and principles of management. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . 6th ed. Philadelphia, ...

Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses.

PubMed

Sahay, Ashlyn; Hutchinson, Marie; East, Leah

2015-05-01

Despite the growing awareness of the benefits of positive workplace climates, unsupportive and disruptive workplace behaviours are widespread in health care organisations. Recent graduate nurses, who are often new to a workplace, are particularly vulnerable in unsupportive climates, and are also recognised to be at higher risk for medication errors. Investigate the association between workplace supports and relationships and safe medication practice among graduate nurses. Exploratory study using quantitative survey with a convenience sample of 58 nursing graduates in two Australian States. Online survey focused on graduates' self-reported medication errors, safe medication practice and the nature of workplace supports and relationships. Spearman's correlations identified that unsupportive workplace relationships were inversely related to graduate nurse medication errors and erosion of safe medication practices, while supportive Nurse Unit Manager and supportive work team relationships positively influenced safe medication practice among graduates. Workplace supports and relationships are potentially both the cause and solution to graduate nurse medication errors and safe medication practices. The findings develop further understanding about the impact of unsupportive and disruptive behaviours on patient safety and draw attention to the importance of undergraduate and continuing education strategies that promote positive workplace behaviours and graduate resilience. Copyright © 2015 Elsevier Ltd. All rights reserved.

Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?

PubMed

Matricciani, Lisa; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T; Olds, Tim S

2013-04-01

It is widely recognized that sleep is important for children's health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to children's sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.

SMART DOCS: A New Patient-Centered Outcomes and Coordinated-Care Management Approach for the Future Practice of Sleep Medicine

PubMed Central

Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R.; Cohen, Elyse; Manber, Rachel; Walsh, James K.

2015-01-01

The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02037438. Citation: Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated

Best Practice Guide for the Treatment of REM Sleep Behavior Disorder (RBD)

PubMed Central

Aurora, R. Nisha; Zak, Rochelle S.; Maganti, Rama K.; Auerbach, Sanford H.; Casey, Kenneth R.; Chowdhuri, Susmita; Karippot, Anoop; Ramar, Kannan; Kristo, David A.; Morgenthaler, Timothy I.

2010-01-01

Summary of Recommendations: Modifying the sleep environment is recommended for the treatment of patients with RBD who have sleep-related injury. Level A Clonazepam is suggested for the treatment of RBD but should be used with caution in patients with dementia, gait disorders, or concomitant OSA. Its use should be monitored carefully over time as RBD appears to be a precursor to neurodegenerative disorders with dementia in some patients. Level B Clonazepam is suggested to decrease the occurrence of sleep-related injury caused by RBD in patients for whom pharmacologic therapy is deemed necessary. It should be used in caution in patients with dementia, gait disorders, or concomitant OSA, and its use should be monitored carefully over time. Level B Melatonin is suggested for the treatment of RBD with the advantage that there are few side effects. Level B Pramipexole may be considered to treat RBD, but efficacy studies have shown contradictory results. There is little evidence to support the use of paroxetine or L-DOPA to treat RBD, and some studies have suggested that these drugs may actually induce or exacerbate RBD. There are limited data regarding the efficacy of acetylcholinesterase inhibitors, but they may be considered to treat RBD in patients with a concomitant synucleinopathy. Level C The following medications may be considered for treatment of RBD, but evidence is very limited with only a few subjects having been studied for each medication: zopiclone, benzodiazepines other than clonazepam, Yi-Gan San, desipramine, clozapine, carbamazepine, and sodium oxybate. Level C Citation: Aurora RN; Zak RS; Maganti RK; Auerbach SH; Casey KR; Chowdhuri S; Karippot A; Ramar K; Kristo DA; Morgenthaler TI. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med 2010;6(1):85-95. PMID:20191945

Monitoring sleep depth: analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation.

PubMed

Giménez, Sandra; Romero, Sergio; Alonso, Joan Francesc; Mañanas, Miguel Ángel; Pujol, Anna; Baxarias, Pilar; Antonijoan, Rosa Maria

2017-02-01

The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. Due to similarities in EEG synchronization between anesthesia and sleep, several studies have assessed BIS as a sleep monitor with contradictory results. The aim of this study was to evaluate objectively both the feasibility and reliability of BIS for sleep monitoring through a robust methodology, which included full PSG recordings at a baseline situation and after 40 h of sleep deprivation. Results confirmed that the BIS index was highly correlated with the hypnogram (0.89 ± 0.02), showing a progressive decrease as sleep deepened, and an increase during REM sleep (awake: 91.77 ± 8.42; stage N1: 83.95 ± 11.05; stage N2: 71.71 ± 11.99; stage N3: 42.41 ± 9.14; REM: 80.11 ± 8.73). Mean and median BIS values were lower in the post-deprivation night than in the baseline night, showing statistical differences for the slow wave sleep (baseline: 42.41 ± 9.14 vs. post-deprivation: 39.49 ± 10.27; p = 0.02). BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care.

Sleep Hygiene and Sleep Quality of Third-Trimester Pregnant Women.

PubMed

Tsai, Shao-Yu; Lee, Chien-Nan; Wu, Wei-Wen; Landis, Carol A

2016-02-01

The purpose of this descriptive study was to examine the associations of sleep hygiene and actigraphy measures of sleep with self-reported sleep quality in 197 pregnant women in northern Taiwan. Third-trimester pregnant women completed the Sleep Hygiene Practice Scale (SHPS) and the Pittsburgh Sleep Quality Index (PSQI) as well as the Center for Epidemiologic Studies-Depression Scale (CES-D), and wore an actigraph for 7 consecutive days. Student's t-test was used to compare the SHPS scores and means as well as variability of actigraphy sleep variables between poor sleepers (i.e., PSQI global score >5) and good sleepers (i.e., PSQI global score ≤5). Compared to good sleepers, poor sleepers reported significantly worse sleep hygiene, with higher SHPS scores and higher sleep schedule, arousal-related behavior, and sleep environment subscale scores. Poor sleepers had significantly greater intra-individual variability of sleep onset latency, total nighttime sleep, and wake after sleep onset than good sleepers. In stepwise linear regression, older maternal age (p = .01), fewer employment hours per week (p = .01), higher CES-D total score (p < .01), and higher SHPS arousal-related behavior subscale scores (p < .01) predicted self-reported global sleep quality. Findings support avoiding physically, physiologically, emotionally, or cognitively arousing activities before bedtime as a target for sleep-hygiene intervention in women during pregnancy. © 2015 Wiley Periodicals, Inc.

National Athletic Trainers' Association position statement: safe weight loss and maintenance practices in sport and exercise.

PubMed

Turocy, Paula Sammarone; DePalma, Bernard F; Horswill, Craig A; Laquale, Kathleen M; Martin, Thomas J; Perry, Arlette C; Somova, Marla J; Utter, Alan C

2011-01-01

To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals. Unsafe weight management practices can compromise athletic performance and negatively affect health. Athletes and clients often attempt to lose weight by not eating, limiting caloric or specific nutrients from the diet, engaging in pathogenic weight control behaviors, and restricting fluids. These people often respond to pressures of the sport or activity, coaches, peers, or parents by adopting negative body images and unsafe practices to maintain an ideal body composition for the activity. We provide athletic trainers with recommendations for safe weight loss and weight maintenance in sport and exercise. Although safe weight gain is also a concern for athletic trainers and their athletes and clients, that topic is outside the scope of this position statement. Athletic trainers are often the source of nutrition information for athletes and clients; therefore, they must have knowledge of proper nutrition, weight management practices, and methods to change body composition. Body composition assessments should be done in the most scientifically appropriate manner possible. Reasonable and individualized weight and body composition goals should be identified by appropriately trained health care personnel (eg, athletic trainers, registered dietitians, physicians). In keeping with the American Dietetics Association (ADA) preferred nomenclature, this document uses the terms registered dietitian or dietician when referring to a food and nutrition expert who has met the academic and professional requirements specified by the ADA's Commission on Accreditation for Dietetics Education. In some cases, a registered nutritionist may have equivalent credentials and be the

National Athletic Trainers' Association Position Statement: Safe Weight Loss and Maintenance Practices in Sport and Exercise

PubMed Central

Turocy, Paula Sammarone; DePalma, Bernard F.; Horswill, Craig A.; Laquale, Kathleen M.; Martin, Thomas J.; Perry, Arlette C.; Somova, Marla J.; Utter, Alan C.

2011-01-01

Objective: To present athletic trainers with recommendations for safe weight loss and weight maintenance practices for athletes and active clients and to provide athletes, clients, coaches, and parents with safe guidelines that will allow athletes and clients to achieve and maintain weight and body composition goals. Background: Unsafe weight management practices can compromise athletic performance and negatively affect health. Athletes and clients often attempt to lose weight by not eating, limiting caloric or specific nutrients from the diet, engaging in pathogenic weight control behaviors, and restricting fluids. These people often respond to pressures of the sport or activity, coaches, peers, or parents by adopting negative body images and unsafe practices to maintain an ideal body composition for the activity. We provide athletic trainers with recommendations for safe weight loss and weight maintenance in sport and exercise. Although safe weight gain is also a concern for athletic trainers and their athletes and clients, that topic is outside the scope of this position statement. Recommendations: Athletic trainers are often the source of nutrition information for athletes and clients; therefore, they must have knowledge of proper nutrition, weight management practices, and methods to change body composition. Body composition assessments should be done in the most scientifically appropriate manner possible. Reasonable and individualized weight and body composition goals should be identified by appropriately trained health care personnel (eg, athletic trainers, registered dietitians, physicians). In keeping with the American Dietetics Association (ADA) preferred nomenclature, this document uses the terms registered dietitian or dietician when referring to a food and nutrition expert who has met the academic and professional requirements specified by the ADA's Commission on Accreditation for Dietetics Education. In some cases, a registered nutritionist may have

Safe sedation practices among gastroenterology registrars: do we need more training?

PubMed Central

Mohanaruban, Aruchuna; Bryce, Kathleen; Radhakrishnan, Archchana; Gallaher, Joseph; Johnson, Gavin

2015-01-01

Endoscopy training is a central component of gastroenterology training for the vast majority of UK trainees, and integral to this is the practice of safe sedation. The majority of endoscopic procedures are performed with the patient under conscious sedation with a benzodiazepine, often combined with an opioid. Little data exists on the practice of sedation among gastroenterology trainees, including their degree of knowledge of the common sedation agents used and their actions. Using both an online and paper-based questionnaire, we surveyed current gastroenterology speciality trainees (ST) in the UK and received 78 responses giving a response rate of 10%. Fifty-one per cent of the trainees did not receive structured training in safe sedation, despite national guidelines advising this to be an essential part of the training programme, and 92% felt a structured sedation course would be beneficial. We also identified some gaps in trainees’ knowledge of the action of sedation agents. We propose that a formal training session in sedation or an e-learning module could be incorporated as part of a deanery or trust induction for gastroenterology trainees and kept under regular review. PMID:28839813

Amount and quality of sleep: exploring the role of stress and work experience in a sample of obstetrician-gynecologists.

PubMed

Taouk, Laura; Farrow, Victoria A; Schulkin, Jay

2017-05-02

Sufficient sleep is necessary for optimal performance and the delivery of safe and effective health care. To establish an empirical understanding of physician fatigue, the present study investigated the factors that contributed to the amount and the quality of sleep among obstetricians and gynecologists (ob-gyns). A survey of personal and work experiences was sent to 495 eligible physicians belonging to the American College of Obstetricians and Gynecologists (ACOG). Data were obtained from 287 ob-gyns for a response rate of 58.0%. Associations between sleep-related items and measures of stress and work-related factors were explored. Ob-gyns in our sample reported sleeping an average of 6.5 hours a night with 29.2% indicating that they received very or fairly bad quality of sleep. Average amount and quality of sleep were found to be independently related to the hours worked weekly, colleague support for a work-home balance, practice setting, perceived work-control, physician-specific stressors and perceived stress. In summary models, hours worked and perceived stress scores consistently emerged as predictors of amount of sleep. Overall, findings explained a small portion of the variance in sleep. Considering the multitude of factors that contribute to sleep, subtle associations warrant further investigation.

Sleep-hygiene Education improves Sleep Indices in Elite Female Athletes.

PubMed

O'Donnell, Shannon; Driller, Matthew W

2017-01-01

The importance of sleep in providing psychophysiological recovery in elite athletes is often overlooked. In other populations (eg shift workers and adolescent students), sleep hygiene education may serve to acutely improve sleep indices. However, this is yet to be examined in an elite athlete setting. Therefore, the aim of the current study was to evaluate the effect of a sleep hygiene education session on sleep indices in elite athletes. The study involved 26 elite female netball athletes performing one week of baseline sleep monitoring (PRE), followed by a sleep hygiene education session and a further week of sleep monitoring (POST) in a single group, pre- post design. The sleep hygiene education session focused on providing information on the importance of sleep for athletes and practical tips to improve sleep quality and quantity. Sleep monitoring was performed using wrist actigraphy to assess total sleep time (TST), sleep efficiency (SE%), total time in bed (TTB), sleep latency (SL), wake episodes per night (WE), sleep onset variance (SOV), wake variance (WV) wake episode duration (WED), sleep onset time (SOT), and wake time (WT). There was a significant improvement in TST (mean ± SD; 22.3 ± 39.9 minutes, p=0.01) PRE to POST sleep hygiene education session, the difference associated with a small effect (ES: 0.39). A significant improvement PRE to POST was found for WV (p=0.03), and for WED (p=0.03). There were no significant differences for SE%, SL, TTB, WE, SOV, SOT, WT. The current study reports that a sleep hygiene education session is effective in improving sleep quantity in elite female athletes in an acute setting.

[The NHG guideline 'Sleep problems and sleeping pills'].

PubMed

Damen-van Beek, Zamire; Lucassen, Peter L B J; Gorgels, Wim; Smelt, Antonette F H; Knuistingh Neven, Arie; Bouma, Margriet

2015-01-01

The Dutch College of General Practitioners' (NHG) guideline 'Sleep problems and sleeping pills' provides recommendations for the diagnosis and treatment of the most prevalent sleep problems and for the management of chronic users of sleeping pills. The preferred approach for sleeplessness is not to prescribe medication but to give information and behavioural advice. Practice assistants of the Dutch Association of Mental Health and Addiction Care are also expected to be able to undertake this management. The GP may consider prescribing sleeping pills for a short period only in cases of severe insomnia with considerable distress. Chronic users of sleeping pills should be advised by the GP to stop using them or to reduce the dose gradually (controlled dose reduction). The GP may refer patients with suspected obstructive sleep apnoea (OSA) to a pulmonary or ear, nose and throat specialist or neurologist for further diagnosis depending on the regional arrangements. The GP may then consider the cardiovascular risk factors commonly present with OSA. In patients with restless legs syndrome (RLS) who continue to experience major distress despite being given advice without the prescription of medication, the GP may consider prescribing a dopamine agonist.

Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults.

PubMed

Aurora, R Nisha; Casey, Kenneth R; Kristo, David; Auerbach, Sanford; Bista, Sabin R; Chowdhuri, Susmita; Karippot, Anoop; Lamm, Carin; Ramar, Kannan; Zak, Rochelle; Morgenthaler, Timothy I

2010-10-01

Practice parameters for the treatment of obstructive sleep apnea syndrome (OSAS) in adults by surgical modification of the upper airway were first published in 1996 by the American Academy of Sleep Medicine (formerly ASDA). The following practice parameters update the previous practice parameters. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. A systematic review of the literature was performed, and the GRADE system was used to assess the quality of evidence. The findings from this evaluation are provided in the accompanying review paper, and the subsequent recommendations have been developed from this review. The following procedures have been included: tracheostomy, maxillo-mandibular advancement (MMA), laser assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), radiofrequency ablation (RFA), and palatal implants. The presence and severity of obstructive sleep apnea must be determined before initiating surgical therapy (Standard). The patient should be advised about potential surgical success rates and complications, the availability of alternative treatment options such as nasal positive airway pressure and oral appliances, and the levels of effectiveness and success rates of these alternative treatments (Standard). The desired outcomes of treatment include resolution of the clinical signs and symptoms of obstructive sleep apnea and the normalization of sleep quality, the apnea-hypopnea index, and oxyhemoglobin saturation levels (Standard). Tracheostomy has been shown to be an effective single intervention to treat obstructive sleep apnea. This operation should be considered only when other options do not exist, have failed, are refused, or when this operation is deemed necessary by clinical urgency (Option). MMA is indicated for surgical treatment of severe OSA in patients who cannot tolerate or who are unwilling to adhere to positive airway pressure therapy, or in whom oral

Knowledge, attitudes and practices on tsetse and sleeping sickness among communities living in and around Serengeti National Park, Tanzania.

PubMed

Kinung'hi, S M; Malele, I I; Kibona, S N; Matemba, L E; Sahani, J K; Kishamawe, C; Mlengeya, T D K

2006-09-01

A study was undertaken to investigate knowledge, attitudes and practices about sleeping sickness (human African trypanosomiasis) among communities living in and around Serengeti National Park (SENAPA). Structured questionnaires were administered to a total of 1490 consenting participants. Of the respondents, 924 (62%) knew sleeping sickness, and 807 (87.3%) knew the right place to seek healthcare. Of 924 who knew sleeping sickness, 386 (42%) said the disease was present in the areas they live. Most respondents (85.4%) knew that sleeping sickness infections were acquired in the bush and forest. The most common (69.3%) sources of information about sleeping sickness were relatives and friends. Symptoms of sleeping sickness mentioned included abnormal sleep (45.2%), fever (35.3%), body malaise (14.5%), headache (7.6%) and lymph node enlargement (6.1%). Of 1490 people interviewed 90.4% knew tsetse flies and 89.8% had been bitten by tsetse flies. The majority (86.6%) of the respondents knew that sleeping sickness is transmitted through a tsetse bite. Activities that exposed people to tsetse bites included working in tsetse infested bushes/forests, grazing livestock in tsetse infested areas and hunting game animals. In conclusion, communities living in and around SENAPA were knowledgeable about tsetse and sleeping sickness. The communities can thus understand and support community based tsetse and sleeping sickness control programmes to ensure success.

Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.

PubMed

Sateia, Michael J; Buysse, Daniel J; Krystal, Andrew D; Neubauer, David N; Heald, Jonathan L

2017-02-15

The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults. The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, and patient values and preferences. Literature reviews are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations. The AASM Board of Directors approved the final recommendations. The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults, when such treatment is indicated. Under GRADE, a STRONG recommendation is one that clinicians should, under most circumstances, follow. A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients, but should not be construed as an indication of ineffectiveness. GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient, but rather, to the strength of evidence in published data. Downgrading

Sleeping Habits among School Children and their Effects on Sleep Pattern.

PubMed

Mishra, Apurva; Pandey, Ramesh Kumar; Minz, Anurag; Arora, Varuni

2017-12-01

Introduction: Sleep problems can occur at any age. Inadequate sleep affects the physiological as well as psychological well-being of an individual. Thus, the objective of the present study is, to determine the pre sleep habits, duration and pattern of sleep among school children and to determine association between their sleep schedules and sleep habits. Methods: This cross-sectional study comprised of 1050 children attending the government school. Based on inclusion and exclusion criteria children were from three age groups: 4-5 years, 6-10 years and 11-15 years of age. A questionnaire about demographical data, sleep problems and habits, was duly filled by the parents. The parents of children were questioned for bed time, wakeup time, sleep time and sleep duration during both weekdays and weekends. Results: Total sleep time during weekdays was 8.9 (1.2) hours and 10.7 (1.1) hours during weekends. The wakeup time was significantly delayed during weekends in all age groups. Moreover, total sleep time increased significantly during weekends in all age groups. Children using media after 8 pm and sleeping alone are also in significant sleep debt. Screen activities such as TV, internet and cellular phones in a child's bedroom had a negative effect on children's sleep/wake patterns and duration of sleep. Children in higher grades are sleep debt compared to younger ones. Practices such as co sleeping and sharing bed with parents significantly improve the duration and quality of sleep. Conclusion: The sleep durations reported in the present study were lower than recommended sleep duration for children.

APIC position paper: safe injection, infusion, and medication vial practices in health care.

PubMed

Dolan, Susan A; Felizardo, Gwenda; Barnes, Sue; Cox, Tracy R; Patrick, Marcia; Ward, Katherine S; Arias, Kathleen Meehan

2010-04-01

Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings. 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Family and cultural influences on sleep development.

PubMed

Giannotti, Flavia; Cortesi, Flavia

2009-10-01

Sleep is a biopsychosocial process that is influenced by the complex interaction of biologic rhythms, including sleep homeostatic mechanisms, chronobiologic factors, parenting, and temperament. However, family structure, culturally specific values, and beliefs are all elements that impact the ecology of a child's sleep. Dramatic demographic changes in many countries have been witnessed in recent years, which have resulted in health professionals and pediatricians being confronted with families of widely differing cultural origins. Attitudes and beliefs on infant sleeping strongly influence whether or not infant sleep behavior is perceived as problematic. Thus, it is advantageous to explore a child's sleep behavior in a multicultural setting. Cultural comparisons are of intrinsic value because they allow not only a better understanding of sleep in different contexts but also an evaluation of the eventual benefits and consequences of different cultural sleep practices. This article provides an overview of some specific sleep-related behaviors and practices highly influenced by different cultural contexts.

Experience of isolated sleep paralysis in clinical practice in Nigeria.

PubMed

Ohaeri, J U

1992-06-01

The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment.

Perceived neighborhood safety and sleep quality: a global analysis of six countries.

PubMed

Hill, Terrence D; Trinh, Ha Ngoc; Wen, Ming; Hale, Lauren

2016-02-01

Building on previous North American and European studies of neighborhood context and sleep quality, we tested whether several self-reported sleep outcomes (sleep duration, insomnia symptoms, sleepiness, lethargy, and overall sleep quality) vary according to the level of perceived neighborhood safety in six countries: Mexico, Ghana, South Africa, India, China, and Russia. Using data (n = 39,590) from Wave I of the World Health Organization's Longitudinal Study on Global Ageing and Adult Health (2007-2010), we estimated a series of multinomial and binary logistic regression equations to model each sleep outcome within each country. Taken together, our results show that respondents who feel safe from crime and violence in their neighborhoods tend to exhibit more favorable sleep outcomes than respondents who feel less safe. This general pattern is especially pronounced in China and Russia, moderately evident in Mexico, Ghana, and South Africa, and sporadic in India. Perceptions of neighborhood safety are strongly associated with insomnia symptoms and poor sleep quality (past 30 days), moderately associated with sleepiness, lethargy, and poor sleep quality (past 2 days), and inconsistently associated with sleep duration (past two days). We show that perceived neighborhood safety is associated with more favorable self-reported sleep outcomes in six understudied countries. Additional research is needed to replicate our findings using longitudinal data, more reliable neighborhood measures, and more direct measures of sleep quality in these and other regions of the world. Copyright © 2014 Elsevier B.V. All rights reserved.

Wireless sleep measurement: sensing sleep and breathing patterns using radio-frequency sensors.

PubMed

Heneghan, Conor

2014-01-01

Despite the fact that we spend nearly one third of our lives asleep, surprisingly little was known about sleep until the 20th century. Now, sleep medicine is firmly established as a significant branch of medical practice, taking its roots strongly from the work of Nathaniel Kleitman and colleagues at the University of Chicago in the 1950s. They were the first to show the existence of rapid eye movement (REM) sleep?commonly associated with ?dreaming?and began the process of opening our eyes to the complex physiological processes that occur during sleep.

Sleeping in fits and starts: a practical guide to distinguishing nocturnal epilepsy from sleep disorders.

PubMed

Derry, Christopher P

2014-12-01

Accurately diagnosing sleep-related events, and particularly distinguishing nocturnal frontal lobe seizures from other sleep disorders such as parasomnias, can be challenging. This article reviews the differential diagnosis of paroxysmal events from sleep, epileptic and non-epileptic, considers important diagnostic points in the history, and evaluates the role of investigations in this setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Children's Sleep Regulation Is Linked to Mothers' Sleep-Related Childhood Experiences

ERIC Educational Resources Information Center

Aviezer, Ora; Scher, Anat

2013-01-01

The present research explored how mothers' own childhood experiences are linked to their perceptions of their children's sleep regulation. It focused on collective sleeping; a practice used in the past in the Israeli kibbutz, and used a quasi-experimental research design to examine whether mothers who were raised in collective sleeping…

APIC position paper: Safe injection, infusion, and medication vial practices in health care.

PubMed

Dolan, Susan A; Arias, Kathleen Meehan; Felizardo, Gwen; Barnes, Sue; Kraska, Susan; Patrick, Marcia; Bumsted, Amelia

2016-07-01

The transmission of bloodborne viruses and other microbial pathogens to patients during routine health care procedures continues to occur because of the use of improper injection, infusion, medication vial, and point-of-care testing practices by health care personnel. These unsafe practices occur in various clinical settings and result in unacceptable and devastating events for patients. This document updates the Association for Professionals in Infection Control and Epidemiology 2010 position paper on safe injection, infusion, and medication vial practices in health care. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Orthodontic view in the diagnoses of obstructive sleep apnea

PubMed Central

Banabilh, Saeed M

2017-01-01

Obstructive sleep apnea is an exciting area for orthodontists to be involved. The level of awareness of sleep apnea and related health issues is growing rapidly. The demand of integrating sleep into the orthodontic practice shortly will be driven by the need of the societies as some of our patients will be shortly coming into our offices aware of sleep apnea. However, with our busy clinical orthodontic practice, the need of condense short review become more demanding. Therefore, this review will try to summarize the clinical and orthodontic observation in the diagnoses of adult obstructive sleep apnea with clinical application in orthodontic practice. PMID:28717631

Why do we need sleep? Relating theory to nursing practice.

PubMed

Hodgson, L A

1991-12-01

By reviewing the literature, this paper explores the nature and function of sleep. Most of the evidence for the functional theories of sleep has been obtained as a result of examining the effects of sleep deprivation, the physiological, emotional and behavioural effects of which are discussed. There is a discussion on how an awareness of the theoretical knowledge may help in the nursing care of patients with advanced cancer and other chronic diseases, as well as their carers. The physiological effects of stress, and the possible relationship to patients and their carers, leads the author to highlight the need for further research, and possible benefit of proactive intervention for the bereaved. The effects of poor nutrition and common symptoms such as pain and dyspnoea on sleep, and the iatrogenic causes of sleep disturbances, are discussed. The importance of individualized patient care is stressed. The conclusion is drawn that although researchers do not seem to have been able to prove conclusively any essential function of sleep, the nurse is in a unique position to facilitate and enable patients and their carers to cope during the waking hours, without the added stress that sleep disruption and deprivation bring.

Effect of Melatonin Administration on Sleep Quality in Sulfur Mustard Exposed Patients with Sleep Disorders

PubMed Central

Mousavi, Seyyedeh Soghra; Shohrati, Majid; Vahedi, Ensieh; Abdollahpour-Alitappeh, Meghdad; Panahi, Yunes

2018-01-01

Sulfur mustard (SM) is a toxic agent that targets several tissues. It is the leading cause of persistent lung disease, progressive deterioration in lung function, and mortality among injured patients. Disturbed sleep and poor quality of sleep are common in SM-exposed patients with chronic respiratory problems. Melatonin is an alternative medication that has been widely used to treat poor sleep quality caused by several specific conditions. This study aimed to evaluate the efficacy of melatonin administration in improvement of sleep quality in SM-injured patients. In this randomized, double-blind and placebo-controlled trial study a total of 30 SM-exposed male patients were recruited. Patients received 3 mg melatonin (N = 15) or placebo (N = 15), orally in a single dose, 1 h before bedtime for 56 consecutive days. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was measured by Epworth Sleepiness Scale (ESS), and the risk of obstructive sleep apnea was determined by STOP-Bang questionnaire. Compared with placebo, melatonin administration significantly improved global PSQI score, particularly sleep latency (P = 0.03) and subjective sleep quality (P = 0.004). Mean of global PSQI score was declined significantly (P = 0.01) from 10.13 ± 3.44 to 6.66 ± 3.08 in melatonin group. No differences in ESS and STOP-Bang scores were observed between two groups. Melatonin was effective in improving global PSQI score and sleep latency, but not daytime sleepiness and obstructive sleep apnea in SM-exposed patients. Further long-term studies involving larger number of patients are needed before melatonin can be safely recommended for the management of sleep disturbances in these patients.

Sleep disorders, epilepsy, and autism.

PubMed

Malow, Beth A

2004-01-01

The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum disorders. Epilepsy and sleep have reciprocal relationships, with sleep facilitating seizures and seizures adversely affecting sleep architecture. The hypothesis put forth is that identifying and treating sleep disorders, which are potentially caused by or contributed to by autism, may impact favorably on seizure control and on daytime behavior. The article concludes with some practical suggestions for the evaluation and treatment of sleep disorders in this population of children with autism.

Sleep of Parents Living With a Child Receiving Hospital-Based Home Care: A Phenomenographical Study.

PubMed

Angelhoff, Charlotte; Edéll-Gustafsson, Ulla; Mörelius, Evalotte

2015-01-01

Caring for an ill child at home gives the family the chance to be together in a familiar environment. However, this involves several nocturnal sleep disturbances, such as frequent awakenings and bad sleep quality, which may affect parents' ability to take care of the child and themselves. The aim of this study was to describe parents' perceptions of circumstances influencing their own sleep when living with a child enrolled in hospital-based home care (HBHC) services. This is a phenomenographical study with an inductive, exploratory design. Fifteen parents (11 mothers and 4 fathers) with children enrolled in HBHC services were interviewed. Data were analyzed to discover content-related categories describing differences in ways parents experienced sleep when caring for their children receiving HBHC. Four descriptive categories were detected: sleep influences mood and mood influences sleep; support influences safeness and safeness influences sleep; the child's needs influence routines and routines influence sleep; and "me time" influences sleep. Sleep does not affect only the parents' well-being but also the child's care. Symptoms of stress may limit the parents' capacity to meet the child's needs. Support, me time, and physical activity were perceived as essential sources for recovery and sleep. It is important for nurses to acknowledge parental sleep in the child's nursing care plan and help the parents perform self-care to promote sleep and maintain life, health, and well-being.

Correlates to sleepiness on night shift among male workers engaged in three-shift work in a chemical plant: its association with sleep practice and job stress.

PubMed

Kageyama, Takayuki; Kobayashi, Toshio; Abe-Gotoh, Ayano

2011-01-01

The purpose of this study was to examine the correlation of sleepiness during night shift (SNS) in male shiftworkers with nonpharmacological self-management (nPSM) practices to facilitate good day sleep, and also with job stress. Sleepiness on the job and possible correlates to SNS among 157 male shiftworkers in a rotating three-shift schedule at a chemical plant were cross-sectionally investigated using a self-administered questionnaire. Multivariate analyses revealed that SNS was positively associated with drinking alcoholic beverages before day sleep, but inversely associated with subjective health status, being of the evening type, abstaining from caffeine before day sleep, having a bath before day sleep, job control, reward from work, feeling suited to the job, and support from colleagues. SNS correlated with certain nPSM practices and also with possible modifiers of job stress. These findings provide clues to developing countermeasures against SNS among shiftworkers. The effects of nPSM practices and job stress management on their day sleep and SNS should be examined in detail.

Practice Parameters for the Treatment of Narcolepsy and other Hypersomnias of Central Origin An American Academy of Sleep Medicine Report

PubMed Central

Morgenthaler, Timothy I.; Kapur, Vishesh K.; Brown, Terry; Swick, Todd J.; Alessi, Cathy; Aurora, R. Nisha; Boehlecke, Brian; Chesson, Andrew L.; Friedman, Leah; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Zak, Rochelle

2007-01-01

These practice parameters pertain to the treatment of hypersomnias of central origin. They serve as both an update of previous practice parameters for the therapy of narcolepsy and as the first practice parameters to address treatment of other hypersomnias of central origin. They are based on evidence analyzed in the accompanying review paper. The specific disorders addressed by these parameters are narcolepsy (with cataplexy, without cataplexy, due to medical condition and unspecified), idiopathic hypersomnia (with long sleep time and without long sleep time), recurrent hypersomnia and hypersomnia due to medical condition. Successful treatment of hypersomnia of central origin requires an accurate diagnosis, individual tailoring of therapy to produce the fullest possible return of normal function, and regular follow-up to monitor response to treatment. Modafinil, sodium oxybate, amphetamine, methamphetamine, dextroamphetamine, methylphenidate, and selegiline are effective treatments for excessive sleepiness associated with narcolepsy, while tricyclic antidepressants and fluoxetine are effective treatments for cataplexy, sleep paralysis, and hypnagogic hallucinations; but the quality of published clinical evidence supporting them varies. Scheduled naps can be beneficial to combat sleepiness in narcolepsy patients. Based on available evidence, modafinil is an effective therapy for sleepiness due to idiopathic hypersomnia, Parkinson's disease, myotonic dystrophy, and multiple sclerosis. Based on evidence and/or long history of use in the therapy of narcolepsy committee consensus was that modafinil, amphetamine, methamphetamine, dextroamphetamine, and methylphenidate are reasonable options for the therapy of hypersomnias of central origin. Citation: Morgenthaler TI; Kapur VK; Brown T; Swick TJ; Alessi C; Aurora RN; Boehlecke B; Chesson AL; Friedman L; Maganti R; Owens J; Pancer J; Zak R; Standards of Practice Committee of the AASM. Practice parameters for the treatment

Access to Safe Water and Personal Hygiene Practices in the Kulandia Refugee Camp (Jerusalem).

PubMed

Issa, Mohamad; McHenry, Michael; Issa, Abdul Aziz; Blackwood, R Alexander

2015-12-22

Diarrheal illness, frequently associated with fecal-oral transmission, is one of the leading causes of death worldwide. It is commonly preventable through the implementation of safe water practices. This experiment concerns how to best implement safe water practices in a quasi-permanent refugee camp setting with limited ability for structural changes. Specifically, we explore how health promotion activities that help identify target groups for hygiene interventions can play a role in disease prevention. An anonymous survey was conducted at the United Nations Relief and Works Agency Health Clinic in the Kulandia refugee camp to assess the safe water and personal hygiene practices. Demographic and social characteristics, accessible water and personal hygiene characteristics, and gastrointestinal (GI) burden for individuals and their households were assessed. A total of 96 individuals were enrolled; 62 females and 34 males. Approximately 58% of the sample had soap available and washed hands before and after eating and when preparing food. Piped water was the main source of drinking water (62%), while 31% of our sample utilized tanker-trucks. 93% of participants had access to toilet facilities, with 86% of these facilities being private households. 55% practice extra water hygiene measures on their household drinking water source. 51.3% considered vendor cleanliness when they were buying food. 51% had received formal health education. 68.8% had been taught by their parents, but only 55.2% were teaching their children and 15.6% had consistent access to a health professional for hygiene inquiries. Individual variables and hygiene practices associated with lower rates of diarrheal illnesses included having water piped into the home, proper hand washing, adequate soap availability, proper consideration of vendor cleanliness, higher income, levels of education, health hygiene education, and having access to healthcare professions to discuss hygiene related matters. This is

Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background.

PubMed

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E

2014-05-15

To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

Older men's experiences of sleep in the hospital.

PubMed

Lee, Chau Yuen; Low, Lisa Pau Le; Twinn, Sheila

2007-02-01

The aim of this study was to examine the sleep experiences of older patients during a period of hospitalization on an extended care ward. Hospital wards have been demonstrated as environments that are not conducive to sleep for patients. Findings highlight the difficulties of falling asleep and getting insufficient sleep as the major causes of sleep disturbances. Such studies limit themselves to patients of Intensive Care Units and acute care settings. Relatively little is known about understanding the sleep experiences of older patients whilst hospitalized on extended care wards. An exploratory qualitative design was used with a convenience sample of six Chinese male informants, recruited from an extended care ward of a Rehabilitation Hospital in Hong Kong. Multiple data collection methods were used, including repeated semi-structured interviews and a one-week sleep diary. The findings demonstrated that all informants experienced dynamic changes in their sleeping patterns during hospitalization, resulting in sleep disruption and deprivation. The public nature of the ward environment and perceived sense of helplessness significantly interfered with sleep. Some cultural beliefs and practices were perceived by older patients to be associated with the quality of their sleep experiences. The findings contributed to an understanding of the sleep experiences of older patients during hospitalization. Implications for nursing practice indicate the significance of including focused sleep assessment of patients during admission into the ward, so strategies perceived by older patients as being able to improve sleep would be included as part of the usual ward routine and nursing practice, where possible.

Economic implications of sleep disorders.

PubMed

Skaer, Tracy L; Sclar, David A

2010-01-01

Sleep disorders such as insomnia, obstructive sleep apnoea (OSA), excessive daytime sleepiness (EDS) and fatigue, sleep deprivation and restless legs syndrome (RLS) are increasingly seen in clinical practice. Sleep is considered vital for preserving daytime cognitive function and physiological well-being. Sleep insufficiency may have deleterious effects on work-life balance, overall health and safety. The consequential economic burden at both the individual and societal levels is significant. Moreover, sleep disorders are commonly associated with other major medical problems such as chronic pain, cardiovascular disease, mental illness, dementias, gastrointestinal disorders and diabetes mellitus. Thus, in order to properly care for patients presenting with sleep-related morbidity, and to reduce the consequential economic burden, accurate screening efforts and efficacious/cost-effective treatments need to be developed and employed.

[Hygiene in Sleep: Problems of Sleeping Habits in Shift Workers].

PubMed

Takada, Masumi

2018-01-01

Since World War II, Japan has achieved remarkable economic development and has become an advanced country. Particularly in the industrial field, a production system has been developed to reduce the loss of machining time by adopting a shiftwork in factories operating 24 hours a day, which contributes to the improvement of productivity. Nowadays, this shiftwork practice has spread from the industrial field to other businesses such as 24-hour entertainment facilities and convenience stores, which lead to sleep deprivation in Japanese society. Even at home, certain conditions adversely affect sleeping habits. We are concerned about the risks of physical and mental health, impairments posed by the use of tablets, PCs, smartphones, and other devices so popular in today's Japan, as they delay sleep. It is urgent to improve poor sleeping habits because their outcomes such as sleep disorders and deprivation may also lead to traffic and industrial accidents.

Sleep disorders in pregnancy

PubMed Central

Bourjeily, Ghada

2009-01-01

Sleep complaints are a common occurrence in pregnancy that are in part due to pregnancy-associated anatomic and physiological changes but may also be due to pathological causes. In the non-pregnant population, sleep deprivation has been associated with physical and cognitive issues; poor sleep may even be associated with adverse maternal outcomes. Maternal obesity, one of the most prevalent risk factors in obstetric practices, together with physiologic changes of pregnancy predispose to the development of sleep disordered breathing. Symptoms of sleep disordered breathing have also been associated with poor maternal outcomes. Management options of restless legs syndrome and narcolepsy pose a challenge in pregnancy; benefits of therapy need to be weighed against the potential harm to the fetus. This article briefly reviews the normal changes in pregnancy affecting sleep, gives an overview of certain sleep disorders occurring in pregnancy, and suggests management options specific for this population. PMID:27582822

Gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of malaysia.

PubMed

Bin Nordin, R; Araki, S; Sato, H; Yokoyama, K; Bin Wan Muda, W A; Win Kyi, D

2001-01-01

To identify gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of Malaysia, we conducted a 20-item questionnaire interview on storage of pesticide (4 questions), mixing of pesticide (3 questions), use of personal protective equipment and clothing while spraying pesticide (7 questions), activities during and after spraying of pesticide (5 questions), and maintenance of pesticide sprayer (1 question) in 496 tobacco farmers (395 males and 101 females) in Bachok District, Kelantan, Malaysia. Duration of employment was significantly longer in females than those in males (p<0.001). In addition, proportion with no formal education in females was significantly higher than those in males (p<0.05). The following eight common factors were extracted from the 20 questionnaires by principal components factor analysis after varimax rotation in all farmers: (1) use of personal protective equipment, (2) unsafe work habit, (3) reading and following instructions on pesticide label, (4) security, storage and disposal of pesticide container, (5) safe work habit, (6) proper handling of pesticide and maintenance of pesticide sprayer, (7) use of personal protective clothing, and (8) safe handling of pesticide. Results of analysis of covariance for the eight factor scores of all male and female farmers, controlling for educational level and duration of employment, showed that: (1) factor scores for use of personal protective equipment (p<0.001), use of personal protective clothing (p<0.001) and safe work habit (p<0.001) in females were significantly lower than those in males; (2) conversely, factor scores for reading and following instruction on pesticide label (p<0.001) and proper handling of pesticide and maintenance of pesticide sprayer (p<0.01) in males were significantly lower than those in females; and (3) there were no significant differences in other three factor scores (p>0.05). We therefore conclude that: (1) for female tobacco farmers, choice

Gender Difference in Safe and Unsafe Practice of Pesticide Handling in Tobacco Farmers of Malaysia

PubMed Central

BIN NORDIN, Rusli; ARAKI, Shunichi; SATO, Hajime; YOKOYAMA, Kazuhito; BIN WAN MUDA, Wan Abdul Manan; WIN KYI, Daw

2001-01-01

To identify gender difference in safe and unsafe practice of pesticide handling in tobacco farmers of Malaysia, we conducted a 20-item questionnaire interview on storage of pesticide (4 questions), mixing of pesticide (3 questions), use of personal protective equipment and clothing while spraying pesticide (7 questions), activities during and after spraying of pesticide (5 questions), and maintenance of pesticide sprayer (1 question) in 496 tobacco farmers (395 males and 101 females) in Bachok District, Kelantan, Malaysia. Duration of employment was significantly longer in females than those in males (p<0.001). In addition, proportion with no formal education in females was significantly higher than those in males (p<0.05). The following eight common factors were extracted from the 20 questionnaires by principal components factor analysis after varimax rotation in all farmers: (1) use of personal protective equipment, (2) unsafe work habit, (3) reading and following instructions on pesticide label, (4) security, storage and disposal of pesticide container, (5) safe work habit, (6) proper handling of pesticide and maintenance of pesticide sprayer, (7) use of personal protective clothing, and (8) safe handling of pesticide. Results of analysis of covariance for the eight factor scores of all male and female farmers, controlling for educational level and duration of employment, showed that: (1) factor scores for use of personal protective equipment (p<0.001), use of personal protective clothing (p<0.001) and safe work habit (p<0.001) in females were significantly lower than those in males; (2) conversely, factor scores for reading and following instruction on pesticide label (p<0.001) and proper handling of pesticide and maintenance of pesticide sprayer (p<0.01) in males were significantly lower than those in females; and (3) there were no significant differences in other three factor scores (p>0.05). We therefore conclude that: (1) for female tobacco farmers, choice

Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep.

PubMed

Rholdon, Roger

There have been various campaigns and recommendations to decrease the incidence of sudden unexpected infant death. Despite this, caregivers continue to place infants in unsafe sleeping environments. These environments, such as sitting devices, slings, carriers, and car seats, pose a significant risk to an infant's safety because of the risk from suffocation and cardiorespiratory instability. It is important for health care providers to understand the appropriate use of car seats, slings, and other sitting devices, to model appropriate behaviors, and to educate parents and caregivers. All parents, hospital staff, and other caregivers should understand the potential dangers associated with the inappropriate use of sitting devices for routine sleep. © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Sleep, Recovery, and Performance in Sports.

PubMed

Malhotra, Raman K

2017-08-01

Poor sleep can lead to decreases in performance and recovery for athletes. Sleep disorders and symptoms are commonly seen in athletes, and may be unrecognized. It is important to educate athletes on adequate duration, quality, and timing of sleep. Interventions may include changes to practice times or careful planning for travel to games in different time zones. It is important to screen and treat sleep disorders such as sleep apnea and insomnia that are seen in some athletes. In patients who suffer concussion, it is important to address sleep issues, as poor sleep can prolong or exacerbate other concussion symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.

Suvorexant: a dual orexin receptor antagonist for the treatment of sleep onset and sleep maintenance insomnia.

PubMed

Patel, Kunal V; Aspesi, Anthony V; Evoy, Kirk E

2015-04-01

To review the efficacy, safety, and pharmacology data available for suvorexant and determine its role in therapy as compared with other agents available for the treatment of insomnia. A PubMed search using the terms suvorexant and MK-4305 (the original name given to suvorexant during early trials) was conducted in December 2014 to identify initial literature sources. No time frame was used for exclusion of older trials. Animal studies and trials written in a language other than English were excluded. Abstracts of the remaining trials were evaluated for determination of relevance to this review. References from these studies along with suvorexant prescriber information were used to identify additional literature. Three randomized, double-blind, placebo-controlled clinical trials were identified showing suvorexant to be safe, effective, and tolerable for the treatment of insomnia. After 4 weeks of therapy, relative to placebo, the 10- and 20-mg doses improved subjective total sleep time (22.3 and 49.9 minutes, respectively), wake after sleep onset (-21.4 and -28.1 minutes), and latency to persistent sleep (-2.3 and -22.3 minutes). Suvorexant is the first dual orexin receptor antagonist approved for the treatment of insomnia. Clinical trials have shown that it is relatively safe and effective for the treatment of both sleep onset and sleep maintenance at doses of 20 mg or less. Higher doses were studied but not approved because of concerns for next-day somnolence and effects on driving. Further studies are needed to assess this medication in patients with a history of addiction, because they were excluded from clinical trials, as well as to compare suvorexant with other insomnia medications available because no head-to-head studies have yet been conducted. However, its novel mechanism of action and theoretically lower addiction liability make suvorexant an appealing new option. © The Author(s) 2015.

Management of Sleep Disordered Breathing in Patients with Heart Failure.

PubMed

Oates, Connor P; Ananthram, Manjula; Gottlieb, Stephen S

2018-06-01

This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor? Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.

Consequences of the "back to sleep" program in infants.

PubMed

Miller, Lauren C; Johnson, Arlene; Duggan, Lisa; Behm, Melissa

2011-08-01

Sudden infant death syndrome (SIDS) is the third leading cause of infant mortality in the United States and the leading cause of death among infants 28-364 days of age. The "Back to Sleep" program was implemented in 1992 to promote supine sleeping in efforts to prevent SIDS. Along with this implementation came several consequences that are avoidable in infants. The purposes of this article are to describe the Back to Sleep program and its intended purpose, to identify the adverse consequences, and to develop a teaching program for nurse practitioners to use with parents that will both promote safe sleeping and reduce the untoward consequences of the back to sleep program while maintaining the integrity of the SIDS prevention advice. Copyright © 2011 Elsevier Inc. All rights reserved.

Code of Practice for Scientific Diving: Principles for the Safe Practice of Scientific Diving in Different Environments. Unesco Technical Papers in Marine Science 53.

ERIC Educational Resources Information Center

Flemming, N. C., Ed.; Max, M. D., Ed.

This publication has been prepared to provide scientific divers with guidance on safe practice under varying experimental and environmental conditions. The Code offers advice and recommendations on administrative practices, insurance, terms of employment, medical standards, training standards, dive planning, safety with different breathing gases…

Poor sleep quality and insufficient sleep of a collegiate student-athlete population.

PubMed

Mah, Cheri D; Kezirian, Eric J; Marcello, Brandon M; Dement, William C

2018-06-01

Poor and inadequate sleep negatively impact cognitive and physical functioning and may also affect sports performance. The study aim is to examine sleep quality, sleep duration, and daytime sleepiness in collegiate student-athletes across a wide range of sports. Questionnaire. University setting. 628 athletes across 29 varsity teams at Stanford University. Athletes completed a questionnaire inquiring about sleep quality via a modified Pittsburgh Sleep Quality Index (PSQI), sleep duration, and daytime sleepiness via Epworth Sleepiness Scale. Sleep quality on campus and while traveling for competition was rated on a 10-point scale. Collegiate athletes were classified as poor sleepers (PSQI 5.38 ± 2.45), and 42.4% of athletes experience poor sleep quality (reporting PSQI global scores >5). Athletes reported lower sleep quality on campus than when traveling for competition (7.1 vs 7.6, P< .001). Inadequate sleep was demonstrated by 39.1% of athletes that regularly obtain <7 hours of sleep on weekdays. Fifty-one percent of athletes reported high levels of daytime sleepiness with Epworth scores ≥10. Teen student-athletes in the first and second year of college reported the highest mean levels of daytime sleepiness. Greater total sleep time was associated with daytime functioning including lower frequency of difficulty waking up for practice or class (P< .001) and lower frequency of trouble staying awake during daily activities (P< .001). Collegiate athletes frequently experience poor sleep quality, regularly obtain insufficient sleep, and commonly exhibit daytime sleepiness. Copyright © 2018 National Sleep Foundation. All rights reserved.

Safe Sleep for Your Baby: Reduce the Risk of SIDS and Other Sleep-Related Causes of Infant Death

MedlinePlus

... Fast facts about SIDS: SIDS is the leading cause of death in babies 1 month to 1 year of ... baby to die suddenly and unexpectedly. Sleep-related causes of infant death are those linked to how or where a ...

A Safe Ride to School; A Safe Ride Home.

ERIC Educational Resources Information Center

Illinois State Board of Education, Springfield.

Text and illustrations are used to teach safe school bus riding practices. The guide begins with instructions to parents or guardians to set a good example of safe behavior, and to help children learn safety rules and be on time. Instructions to children concern obeying the bus driver, boarding the bus, riding the bus, crossing the road, and using…

Safe meat-handling knowledge, attitudes and practices of private and government meat processing plants' workers: implications for future policy.

PubMed

Adesokan, H K; Raji, A O Q

2014-03-01

Food-borne disease outbreaks remain a major global health challenge and cross-contamination from raw meat due to poor handling is a major cause in developing countries. Adequate knowledge of meat handlers is important in limiting these outbreaks. This study evaluated and compared the safe meat-handling knowledge, attitudes and practices (KAP) of private (PMPP) and government meat processing plants' (GMPP) workers in south-western Nigeria. This cross sectional study comprised 190 meat handlers (PMPP = 55; GMPP = 135). Data concerning their safe meat-handling knowledge, attitudes and practices as well as their socio-demographic characteristics, such as age, gender and work experience were collected. A significant association was observed between the type of meat processing plants and their knowledge (p = 0.000), attitudes (p = 0.000) and practices (p = 0.000) of safe meat-handling. Meat handlers in the GMPP were respectively, about 17 times (OR = 0.060, 95% CI: 0.018-0.203), 57 times (OR = 0.019, 95% CI: 0.007-0.054) and 111 times (OR = 0.009, 95% CI: 0.001- 0.067) less likely to obtain good knowledge, attitude and practice level of safe meat-handling than those from PMPP. Further, KAP levels were significantly associated with age group, education and work experience (p < 0.05). Study findings suggest the need for future policy in food industry in developing countries to accommodate increased involvement of private sector for improved food safety and quality delivery. Public health education on safe food handling and hygiene should be on the front burner among food handlers in general.

Sleep as an Occupational Need.

PubMed

Tester, Nicole J; Foss, Joanne Jackson

In the same way the human body requires food, hydration, and oxygen, it also requires sleep. Even among healthy people, the amount and quality of sleep substantially influence health and quality of life because sleep helps regulate physiological functioning. Given the impact of sleep on participation, the American Occupational Therapy Association reclassified sleep from an activity of daily living to an occupational domain. Poor sleep is a frequent medical complaint, especially among populations with neurological impairment. Occupational therapy practitioners should consider routinely screening for factors affecting their clients' sleep. By addressing such factors, as well as related routines and habits, practitioners can enhance the effectiveness of rehabilitation, promote health and well-being, and increase engagement and life quality. Practitioners should acknowledge the importance of sleep in practice, and the study of sleep should be prioritized by researchers in the field to meet client needs and establish evidence for interventions. Copyright © 2018 by the American Occupational Therapy Association, Inc.

ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice

PubMed Central

Klahn, Shawna; Phillips, Brenda; Parshley, Lisa; Bennett, Peter; Flory, Andi; Calderon, Rosemary

2018-01-01

The purpose of this report is to offer a consensus opinion of ACVIM oncology diplomates and technicians on the safe use of cytotoxic chemotherapeutics in veterinary practice. The focus is on minimizing harm to the personnel exposed to the drugs: veterinary practitioners, veterinary technicians, veterinary staff, and pet owners. The safety of the patient receiving these drugs is also of paramount importance, but is not addressed in this statement. Much of the information presented is based on national recommendations by Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, United States Pharmacopeia, and other published regulations. These directives reflect an abundance of caution to minimize exposure to medical personnel, but large‐scale studies about the consequences of long‐term occupational exposure are not available in veterinary medicine. Challenges in the delivery of optimal treatment safely and economically to veterinary patients in general practice without access to a veterinary oncologist or other specialist, because of costs or proximity, remain. PMID:29603372

Differences in Infant Care Practices and Smoking among Hispanic Mothers Living in the United States.

PubMed

Provini, Lauren E; Corwin, Michael J; Geller, Nicole L; Heeren, Timothy C; Moon, Rachel Y; Rybin, Denis V; Shapiro-Mendoza, Carrie K; Colson, Eve R

2017-03-01

To assess the association between maternal birth country and adherence to the American Academy of Pediatrics safe sleep recommendations in a national sample of Hispanic mothers, given that data assessing the heterogeneity of infant care practices among Hispanics are lacking. We used a stratified, 2-stage, clustered design to obtain a nationally representative sample of mothers from 32 US intrapartum hospitals. A total of 907 completed follow-up surveys (administered 2-6 months postpartum) were received from mothers who self-identified as Hispanic/Latina, forming our sample, which we divided into 4 subpopulations by birth country (US, Mexico, Central/South America, and Caribbean). Prevalence estimates and aORs were determined for infant sleep position, location, breastfeeding, and maternal smoking. When compared with US-born mothers, we found that mothers born in the Caribbean (aOR 4.56) and Central/South America (aOR 2.68) were significantly more likely to room share without bed sharing. Caribbean-born mothers were significantly less likely to place infants to sleep supine (aOR 0.41). Mothers born in Mexico (aOR 1.67) and Central/South America (aOR 2.57) were significantly more likely to exclusively breastfeed; Caribbean-born mothers (aOR 0.13) were significantly less likely to do so. Foreign-born mothers were significantly less likely to smoke before and during pregnancy. Among US Hispanics, adherence to American Academy of Pediatrics safe sleep recommendations varies widely by maternal birth country. These data illustrate the importance of examining behavioral heterogeneity among ethnic groups and have potential relevance for developing targeted interventions for safe infant sleep. Copyright © 2016 Elsevier Inc. All rights reserved.

The Pittsburgh Sleep Diary

NASA Technical Reports Server (NTRS)

Monk, T. H.; Reynolds CF, 3. d.; Kupfer, D. J.; Buysse, D. J.; Coble, P. A.; Hayes, A. J.; Machen, M. A.; Petrie, S. R.; Ritenour, A. M.

1994-01-01

Increasingly, there is a need in both research and clinical practice to document and quantify sleep and waking behaviors in a comprehensive manner. The Pittsburgh Sleep Diary (PghSD) is an instrument with separate components to be completed at bedtime and waketime. Bedtime components relate to the events of the day preceding the sleep, waketime components to the sleep period just completed. Two-week PghSD data is presented from 234 different subjects, comprising 96 healthy young middle-aged controls, 37 older men, 44 older women, 29 young adult controls and 28 sleep disorders patients in order to demonstrate the usefulness, validity and reliability of various measures from the instrument. Comparisons are made with polysomnographic and actigraphic sleep measures, as well as personality and circadian type questionnaires. The instrument was shown to have sensitivity in detecting differences due to weekends, age, gender, personality and circadian type, and validity in agreeing with actigraphic estimates of sleep timing and quality. Over a 12-31 month delay, PghSD measures of both sleep timing and sleep quality showed correlations between 0.56 and 0.81 (n = 39, P < 0.001).

Messaging Affects the Behavior of African American Parents with Regards to Soft Bedding in the Infant Sleep Environment: A Randomized Controlled Trial.

PubMed

Mathews, Anita; Joyner, Brandi L; Oden, Rosalind P; He, Jianping; McCarter, Robert; Moon, Rachel Y

2016-08-01

To evaluate the impact of specific health messages on the decisions of African American parents regarding soft bedding use, specifically related to the high degree of self-efficacy that African American parents have with regards to preventing infant suffocation vs low self-efficacy with regards to sudden infant death syndrome (SIDS) risk reduction. We conducted a randomized, controlled clinical trial of African American mothers of infants. The control group received standard messaging emphasizing safe sleep practices recommended by the American Academy of Pediatrics for the purposes of SIDS risk reduction. The intervention group received enhanced messaging emphasizing safe sleep practices for both SIDS risk reduction and suffocation prevention. Participants completed interviews at 2-3 weeks, 2-3 months, and 5-6 months after the infant's birth. Of 1194 mothers enrolled, 637 completed all interviews. The use of soft bedding both in the past week and last night declined with age (P < .001). Infants in the enhanced group had a lower rate of use of soft bedding in the past week (P = .006) and last night (P = .013). Mothers who received the enhanced message were more likely to state that they avoided soft bedding to protect their infant from suffocation. African American mothers who receive an enhanced message about SIDS risk reduction and suffocation prevention are less likely to use soft bedding in their infant's sleep environment. ClinicalTrials.gov: NCT01361880. Copyright © 2016 Elsevier Inc. All rights reserved.

Interactional Practices Used in the Teaching of Conflict Prevention and Resolution Skills in an Innovative Safe School Program at an Elementary School

ERIC Educational Resources Information Center

Shin, Annalise Grace

2010-01-01

Within the framework of language socialization, this dissertation uses conversation analytic and ethnographic methods to examine the interactional practices used by the adult safe school educator at a progressive elementary school to socialize students into beliefs and practices associated with the school's Cool Tools Safe School Program. Cool…

Implementing AORN recommended practices for a safe environment of care, part II.

PubMed

Kennedy, Lynne

2014-09-01

Construction in and around a working perioperative suite is a challenge beyond merely managing traffic patterns and maintaining the sterile field. The AORN "Recommended practices for a safe environment of care, part II" provides guidance on building design; movement of patients, personnel, supplies, and equipment; environmental controls; safety and security; and control of noise and distractions. Whether the OR suite evolves through construction, reconstruction, or remodeling, a multidisciplinary team of construction experts and health care professionals should create a functional plan and communicate at every stage of the project to maintain a safe environment and achieve a well-designed outcome. Emergency preparedness, a facility-wide security plan, and minimization of noise and distractions in the OR also help enhance the safety of the perioperative environment. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Assessing severity of obstructive sleep apnea by fractal dimension sequence analysis of sleep EEG

NASA Astrophysics Data System (ADS)

Zhang, J.; Yang, X. C.; Luo, L.; Shao, J.; Zhang, C.; Ma, J.; Wang, G. F.; Liu, Y.; Peng, C.-K.; Fang, J.

2009-10-01

Different sleep stages are associated with distinct dynamical patterns in EEG signals. In this article, we explored the relationship between the sleep architecture and fractal dimension (FD) of sleep EEG. In particular, we applied the FD analysis to the sleep EEG of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), which is characterized by recurrent oxyhemoglobin desaturation and arousals from sleep, a disease which received increasing public attention due to its significant potential impact on health. We showed that the variation of FD reflects the macrostructure of sleep. Furthermore, the fast fluctuation of FD, as measured by the zero-crossing rate of detrended FD (zDFD), is a useful indicator of sleep disturbance, and therefore, correlates with apnea-hypopnea index (AHI), and hourly number of blood oxygen saturation (SpO 2) decreases greater than 4%, as obstructive apnea/hypopnea disturbs sleep architecture. For practical purpose, a modified index combining zDFD of EEG and body mass index (BMI) may be useful for evaluating the severity of OSAHS symptoms.

Employment and contextual impact of safe and unsafe sexual practices for STI and HIV: the situation in China.

PubMed

Wang, S M; Gao, M Y

2000-08-01

China's dual employment system plays a crucial role in sexually transmitted infections (STIs) and HIV-related safe and unsafe sexual practices among young Chinese people. Social and psychological determinants of safe and unsafe sexual practices for HIV infection among young people in Sichuan, China were examined. Our findings indicate that changes in China's social structure and employment system impact upon the social contextual involvement and socio-sexual practice of young Chinese people. The findings in the study suggest that the employment-related contextual involvement was a major predictor in the relationships between demography, information, and psychological risk-taking factors on one hand and the people's safe and unsafe sexual practices on the other. Self-employed people (officially called 'getihu') were more likely than the state-employed people to engage in unprotected sex with casual sexual partners. As China undergoes social restructuring and many state-employed people are laid off, the risk may also extend into the broader non-self-employed population as more state-employed people become involved not only in the self-employed getihu's socioeconomic activities but also in their unconventional socio-sexual practices. Collective vulnerability to STI and HIV, due to the current socio-sexual practices of the getihu young people, has created a new frontier for STI and HIV prevention in today's China, as well as demonstrating the importance of collective action with STI and AIDS prevention strategies within relevant social and sub-cultural contexts.

Sleep Patterns, Sleep Disturbances, and Associated Factors Among Chinese Urban Kindergarten Children.

PubMed

Liu, Zhijun; Wang, Guanghai; Geng, Li; Luo, Junna; Li, Ningxiu; Owens, Judith

2016-01-01

This study aimed to characterize sleep patterns and disturbances among Chinese urban kindergarten children and examine potentially associated factors. Caregivers of 513 children (47.96% male) aged 3-6 years (mean age = 4.46, SD = 0.9) completed the Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Almost 80% (78.8%) of the children scored above the original CSHQ cutoff point for global sleep disturbance. Regression analysis indicated that child's age, and the presence of emotional problems, hyperactivity and peer problems, cosleeping, and interparental inconsistency of attitudes toward child rearing accounted for significant variance in the CSHQ total score (R(2) = 22%). These findings indicate that there is an apparently high prevalence of sleep disturbances in Chinese urban kindergarten children; and sleep disturbances are associated with both child-related and parenting practice variables.

Effects of foot reflexology on fatigue, sleep and pain: a systematic review and meta-analysis.

PubMed

Lee, Jeongsoon; Han, Misook; Chung, Younghae; Kim, Jinsun; Choi, Jungsook

2011-12-01

The purpose of this study was to evaluate the effectiveness of foot reflexology on fatigue, sleep and pain. A systematic review and meta-analysis were conducted. Electronic database and manual searches were conducted on all published studies reporting the effects of foot reflexology on fatigue, sleep, and pain. Forty four studies were eligible including 15 studies associated with fatigue, 18 with sleep, and 11 with pain. The effects of foot reflexology were analyzed using Comprehensive Meta-Analysis Version 2.0. The homogeneity and the fail-safe N were calculated. Moreover, a funnel plot was used to assess publication bias. The effects on fatigue, sleep, and pain were not homogeneous and ranged from 0.63 to 5.29, 0.01 to 3.22, and 0.43 to 2.67, respectively. The weighted averages for fatigue, sleep, and pain were 1.43, 1.19, and 1.35, respectively. No publication bias was detected as evaluated by fail-safe N. Foot reflexology had a larger effect on fatigue and sleep and a smaller effect on pain. This meta-analysis indicates that foot reflexology is a useful nursing intervention to relieve fatigue and to promote sleep. Further studies are needed to evaluate the effects of foot reflexology on outcome variables other than fatigue, sleep and pain.

Modifying the Sleep Treatment Education Program for Students to include technology use (STEPS-TECH): Intervention effects on objective and subjective sleep outcomes.

PubMed

Barber, Larissa K; Cucalon, Maria S

2017-12-01

University students often have sleep issues that arise from poor sleep hygiene practices and technology use patterns. Yet, technology-related behaviors are often neglected in sleep hygiene education. This study examined whether the Sleep Treatment Education Program for Students-modified to include information regarding managing technology use (STEPS-TECH)-helps improve both subjective and objective sleep outcomes among university students. Results of an experimental study among 78 university students showed improvements in objective indicators of sleep quantity (total sleep time) and sleep quality (less awakenings) during the subsequent week for students in the STEPS-TECH intervention group compared to a control group. Exploratory analyses indicated that effects were driven by improvements in weekend days immediately following the intervention. There were also no intervention effects on subjective sleep quality or quantity outcomes. In terms of self-reported behavioral responses to educational content in the intervention, there were no group differences in sleep hygiene practices or technology use before bedtime. However, the intervention group reported less technology use during sleep periods than the control group. These preliminary findings suggest that STEPS-TECH may be a useful educational tool to help improve objective sleep and reduce technology use during sleep periods among university students. Copyright © 2017 John Wiley & Sons, Ltd.

Sleep-disordered breathing: a survey of otolaryngologic practice at military hospitals.

PubMed

Davidson, T M; Do, K L

2000-11-01

We conducted a survey of otolaryngologists at all Veterans Administration and Department of Defense hospitals in the United States to ascertain the nature and scope of their treatment of sleep-disordered breathing. Questionnaire responses indicated that head and neck surgeons in military hospitals have a strong interest in the management of patients with snoring and sleep apnea. Because of the difficulty in obtaining timely sleep test results and the low number of referrals from physicians who perform such testing, many otolaryngologists expressed a desire to be able to perform their own sleep testing.

Interactions between sleep disorders and oral diseases.

PubMed

Huynh, N T; Emami, E; Helman, J I; Chervin, R D

2014-04-01

Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Sleep During the Perimenopause: A SWAN Story

PubMed Central

Kravitz, Howard M.; Joffe, Hadine

2011-01-01

Synopsis Is there evidence for a perimenopausal sleep disorder? We address this question in our presentation of the SWAN “sleep story,” in which we summarize and discuss data addressing sleep quality, objective measures of sleep patterns, and sleep disorders that have been published to date by the Study of Women’s Health Across the Nation (SWAN) and the ancillary SWAN Sleep Study. In this review article, we describe what has been learned about sleep during the perimenopause. Analyses exploring racial/ethnic diversity, a hallmark of the SWAN cohort, and the role of hot flashes and mood disturbance in sleep – perimenopause associations are described. Implications for clinical practice are considered. PMID:21961720

The association between sleep quality, low back pain and disability: A prospective study in routine practice.

PubMed

Kovacs, F M; Seco, J; Royuela, A; Betegon, J N; Sánchez-Herráez, S; Meli, M; Martínez Rodríguez, M E; Núñez, M; Álvarez-Galovich, L; Moyá, J; Sánchez, C; Luna, S; Borrego, P; Moix, J; Rodríguez-Pérez, V; Torres-Unda, J; Burgos-Alonso, N; Gago-Fernández, I; González-Rubio, Y; Abraira, V

2018-01-01

The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability. © 2017 European Pain Federation - EFIC®.

Consolidation of Episodic Memories During Sleep

PubMed Central

Racsmány, Mihály; Conway, Martin A.; Demeter, Gyula

2009-01-01

Two experiments investigated the long-term effects of retrieval practice. In the retrieval-practice procedure, selected items from a previously studied list are repeatedly recalled. The typical retrieval-practice effects are considerably enhanced memory for practiced items accompanied by low levels of recall, relative to baseline, for previously studied items that are associated with the practiced items but were not themselves practiced. The two experiments demonstrated that the former effect persisted over 12 hr; the latter effect also persisted over 12 hr, but only if a period of nocturnal sleep occurred during the retention interval. We propose that consolidation processes occurring during sleep, and possibly featuring some form of off-line rehearsal, mediate these long-term effects of retrieval practice. PMID:20424027

A Narrative Review of How Sleep-Related Breathing Disorders and Cardiovascular Diseases Are Linked: An Update for Advanced Practice Registered Nurses.

PubMed

Moon, Chooza; Phelan, Cynthia H; Lauver, Diane R; Bratzke, Lisa C

Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study. Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.

Sleep, circadian rhythms, and psychomotor vigilance.

PubMed

Van Dongen, Hans P A; Dinges, David F

2005-04-01

Psychomotor vigilance performance is highly relevant to athletic performance. It is influenced by a sleep homeostatic process, which builds up pressure for sleep during wakefulness and dissipates this pressure during sleep, and a circadian rhythm process, which produces a waxing and waning of pressure for wakefulness over a 24 hours of the day. During total sleep deprivation, these two processes cause performance to deteriorate progressively over days, modulated within days by further performance reductions at night and relative improvements during the daytime. As the homeostatic pressure for sleep builds up higher across prolonged wakefulness, the rate of dissipation of that pressure during subsequent sleep is enhanced exponentially, so that even brief periods of sleep provide significant performance recuperation. Nevertheless, sleep restriction practiced on a chronic basis induces cumulative performance deficits of the same order of magnitude as observed during total sleep deprivation. There are also considerable individual differences in the degree of vulnerability to performance impairment from sleep loss, and these differences represent a trait.

Saudi regulations for the accreditation of sleep medicine physicians and technologists

PubMed Central

BaHammam, Ahmed S.; Al-Jahdali, Hamdan; AlHarbi, Adel S.; AlOtaibi, Ghazi; Asiri, Saad M.; AlSayegh, Abdulaziz

2013-01-01

The professional content of sleep medicine has grown significantly over the past few decades, warranting the recognition of sleep medicine as an independent specialty. Because the practice of sleep medicine has expanded in Saudi Arabia over the past few years, a national regulation system to license and ascertain the competence of sleep medicine physicians and technologists has become essential. Recently, the Saudi Commission for Health Specialties formed the National Committee for the Accreditation of Sleep Medicine Practice and developed national accreditation criteria. This paper presents the newly approved Saudi accreditation criteria for sleep medicine physicians and technologists. PMID:23440260

Investigation of safe-life fail-safe criteria for the space shuttle

NASA Technical Reports Server (NTRS)

1972-01-01

An investigation was made to determine the effects of a safe-life design approach and a fail-safe design approach on the space shuttle booster vehicle structure, and to recommend any changes to the structural design criteria. Two configurations of the booster vehicle were considered, one incorporating a delta wing (B-9U configuration) and the other a swept wing (B-16B configuration). Several major structural components of the booster were studied to determine the fatigue life, safe-life, and fail-safe capabilities of the baseline design. Each component was investigated to determine the practicability of applying a safe-life or fail-safe design philosophy, the changes such design approaches might require, and the impact of these changes on weight, cost, development plans, and performance.

School-Based Practices and Programs That Promote Safe and Drug-Free Schools. CASE/CCBD Mini-Library Series on Safe, Drug-Free, and Effective Schools.

ERIC Educational Resources Information Center

Guthrie, Patricia M.

This monograph focuses on school-based practices and programs that promote safe and drug-free schools. It begins with a description of the key characteristics of schools with effective programs and provides a model for school-wide support. Necessary steps for developing an effective system of universal prevention are listed and include: (1)…

Sleep budgets in a globalizing world: biocultural interactions influence sleep sufficiency among Egyptian families

PubMed Central

Worthman, Carol M.; Brown, Ryan A.

2013-01-01

Declines in self-reported sleep quotas with globalizing lifestyle changes have focused attention on their possible role in rising global health problems such as obesity or depression. Cultural factors that act across the life course and support sleep sufficiency have received scant attention, nor have the potential interactions of cultural and biological factors in age-related changes in sleep behavior been systematically investigated. This study examines the effects of cultural norms for napping and sleeping arrangements along with sleep schedules, age, and gender on sleep budgets among Egyptian households. Data were collected in 2000 from 16 households with 78 members aged 3–56 years at two sites in Egypt (Cairo and an agrarian village). Each participant provided one week of continuous activity records and details of each sleep event. Records showed that nighttime sleep onsets were late and highly variable. Napping was common and, along with wake time flexibility, played a key role in maintaining sleep sufficiency throughout the life course into later middle age. Cosleeping was prevalent and exhibited contrasting associations with reduced duration and sufficiency of both nocturnal and total sleep, and with earlier, more regular, and less disrupted sleep. Daily sleep quotas met published guidelines and showed age-related changes similar to existing reports, but differed in how they were achieved. Cultural norms organizing sleep practices by age and gender appear to tap their intrinsic biological properties as well. Moreover, flexibility in how sleep was achieved contributed to sleep sufficiency. The findings suggest how biocultural dynamics can play key roles in sleep patterns that sustain favorable sleep quotas from infancy onwards in populations pursuing globalizing contemporary lifestyles. PMID:22651897

Comparison of manual sleep staging with automated neural network-based analysis in clinical practice.

PubMed

Caffarel, Jennifer; Gibson, G John; Harrison, J Phil; Griffiths, Clive J; Drinnan, Michael J

2006-03-01

We have compared sleep staging by an automated neural network (ANN) system, BioSleep (Oxford BioSignals) and a human scorer using the Rechtschaffen and Kales scoring system. Sleep study recordings from 114 patients with suspected obstructed sleep apnoea syndrome (OSA) were analysed by ANN and by a blinded human scorer. We also examined human scorer reliability by calculating the agreement between the index scorer and a second independent blinded scorer for 28 of the 114 studies. For each study, we built contingency tables on an epoch-by-epoch (30 s epochs) comparison basis. From these, we derived kappa (kappa) coefficients for different combinations of sleep stages. The overall agreement of automatic and manual scoring for the 114 studies for the classification {wake / light-sleep / deep-sleep / REM} was poor (median kappa = 0.305) and only a little better (kappa = 0.449) for the crude {wake / sleep} distinction. For the subgroup of 28 randomly selected studies, the overall agreement of automatic and manual scoring was again relatively low (kappa = 0.331 for {wake light-sleep / deep-sleep REM} and kappa = 0.505 for {wake / sleep}), whereas inter-scorer reliability was higher (kappa = -0.641 for {wake / light-sleep / deep-sleep / REM} and kappa = 0.737 for {wake / sleep}). We conclude that such an ANN-based analysis system is not sufficiently accurate for sleep study analyses using the R&K classification system.

46 CFR 108.199 - Arrangement of sleeping spaces.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 4 2014-10-01 2014-10-01 false Arrangement of sleeping spaces. 108.199 Section 108.199... AND EQUIPMENT Construction and Arrangement Accommodation Spaces § 108.199 Arrangement of sleeping spaces. To the extent practicable, each occupation group must be berthed together in sleeping spaces...

46 CFR 108.199 - Arrangement of sleeping spaces.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Arrangement of sleeping spaces. 108.199 Section 108.199... AND EQUIPMENT Construction and Arrangement Accommodation Spaces § 108.199 Arrangement of sleeping spaces. To the extent practicable, each occupation group must be berthed together in sleeping spaces...

46 CFR 108.199 - Arrangement of sleeping spaces.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Arrangement of sleeping spaces. 108.199 Section 108.199... AND EQUIPMENT Construction and Arrangement Accommodation Spaces § 108.199 Arrangement of sleeping spaces. To the extent practicable, each occupation group must be berthed together in sleeping spaces...

46 CFR 108.199 - Arrangement of sleeping spaces.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 4 2012-10-01 2012-10-01 false Arrangement of sleeping spaces. 108.199 Section 108.199... AND EQUIPMENT Construction and Arrangement Accommodation Spaces § 108.199 Arrangement of sleeping spaces. To the extent practicable, each occupation group must be berthed together in sleeping spaces...

46 CFR 108.199 - Arrangement of sleeping spaces.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 4 2013-10-01 2013-10-01 false Arrangement of sleeping spaces. 108.199 Section 108.199... AND EQUIPMENT Construction and Arrangement Accommodation Spaces § 108.199 Arrangement of sleeping spaces. To the extent practicable, each occupation group must be berthed together in sleeping spaces...

Adolescent Sleep and the Impact of Technology Use Before Sleep on Daytime Function

PubMed Central

Johansson, Ann E. E.; Petrisko, Maria A.; Chasens, Eileen R.

2016-01-01

Purpose Technology has become pervasive in our culture, particularly among adolescents. The purpose of this study is to examine associations between use of technology before sleep and daytime function in adolescents. Design and Methods This study is a secondary analysis of respondents aged 13 to 21 years (N= 259) from the 2011 National Sleep Foundation’s Sleep in America Poll. The survey included questions on demographics, sleep habits, and use of technology in the hour before bedtime. Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Student’s t-tests, Mann-Whitney U, and Fischer’s exact tests were performed to detect differences in demographics, sleep duration, and technology use in the total sample, and between respondents with “adequate” compared to “inadequate” sleep. Correlations were calculated between technology frequency and daytime function. Results Adolescents had mean sleep duration of 7.3±1.3 hours. Almost all respondents (97%) used some form of technology before sleep. Increased technology use and the frequency of being awoken in the night by a cell phone were significantly associated with waking too early, waking unrefreshed, and daytime sleepiness (p<0.05). Adolescents who reported “inadequate” sleep had shorter sleep duration, greater frequency of technology use before bedtime, feeling unrefreshed on waking, and greater daytime sleepiness than those reporting “adequate” sleep (all p-values<0.05). Conclusion Technology use before sleep by adolescents had negative consequences on nighttime sleep and on daytime function. Practice Implications Healthcare professionals who interact with adolescents should encourage technology to be curtailed before bedtime and for adolescents to value obtaining adequate sleep. PMID:27184356

Education, safe drinking practices and fetal alcohol spectrum disorder in the Kimberley region of Western Australia.

PubMed

Kavanagh, Phillip S; Payne, Jennifer S

2014-09-01

There are alarming rates of fetal alcohol spectrum disorder (FASD) in the Kimberley region of Western Australia despite numerous international studies demonstrating the links between alcohol consumption during pregnancy and FASD. The aim of this research was to help determine factors that may be associated with correct knowledge about safe drinking practices during pregnancy, with these factors used to help inform future interventions. Ninety-nine residents (40 males, 59 females, 39% of which self-identified as Indigenous) from the Kimberley region (Broome and smaller remote communities) completed a survey examining knowledge of currently recommended safe drinking practices during pregnancy and knowledge of the outcomes for children with FASD over a period of approximately 2 months. The results revealed that education level (i.e. not completing high school through to completing university) is the biggest predictor (β = 0.44, P < 0.01) of knowledge of safe drinking practices during pregnancy, and having heard of FASD (β = 0.67, P < 0.001) was the biggest predictor of knowledge of outcomes for children with FASD. Other variables such as age, sex, Indigenous status and income level were not as important. These findings suggest that early education regarding the consequences of alcohol consumption for women of childbearing age should be paramount in this or similar communities. Suggestions for targeted interventions are discussed in light of these findings. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Start Later, Sleep Later: School Start Times and Adolescent Sleep in Homeschool Versus Public/Private School Students.

PubMed

Meltzer, Lisa J; Shaheed, Keisha; Ambler, Devon

2016-01-01

Homeschooled students provide a naturalistic comparison group for later/flexible school start times. This study compared sleep patterns and sleep hygiene for homeschooled students and public/private school students (grades 6-12). Public/private school students (n = 245) and homeschooled students (n = 162) completed a survey about sleep patterns and sleep hygiene. Significant school group differences were found for weekday bedtime, wake time, and total sleep time, with homeschooled students waking later and obtaining more sleep. Homeschooled students had later school start times, waking at the same time that public/private school students were starting school. Public/private school students had poorer sleep hygiene practices, reporting more homework and use of technology in the hour before bed. Regardless of school type, technology in the bedroom was associated with shorter sleep duration. Later school start times may be a potential countermeasure for insufficient sleep in adolescents. Future studies should further examine the relationship between school start times and daytime outcomes, including academic performance, mood, and health.

Start Later, Sleep Later: School Start Times and Adolescent Sleep in Homeschool vs. Public/Private School Students

PubMed Central

Meltzer, Lisa J.; Shaheed, Keisha; Ambler, Devon

2014-01-01

Homeschool students provide a naturalistic comparison group for later/flexible school start times. This study compared sleep patterns and sleep hygiene for homeschool students and public/private school students (grades 6-12). Public/private school students (n=245) and homeschool students (n=162) completed a survey about sleep patterns and sleep hygiene. Significant school group differences were found for weekday bedtime, wake time, and total sleep time, with homeschool students waking later and obtaining more sleep. Homeschool students had later school start times, waking at the same time that public/private school students were starting school. Public/private school students had poorer sleep hygiene practices, reporting more homework and use of technology in the hour before bed. Regardless of school type, technology in the bedroom was associated with shorter sleep duration. Later school start times may be a potential countermeasure for insufficient sleep in adolescents. Future studies should further examine the relationship between school start times and daytime outcomes, including academic performance, mood, and health. PMID:25315902

Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal.

PubMed

Chaudhuri, Sudip Banik; Ray, Kuntala

2016-01-01

Unsafe injection can transmit many diseases to patients, injection providers and healthy people of community. To find out critical steps whether executed according to recommended best practice methods, availability of equipments in health facilities for safe injection practices and some important steps of waste disposal methods. This facility-based cross-sectional observational study was conducted among 30 Auxiliary nurse midwives (ANM) & 27 nursing staffs (NS) to assess certain aspects of their practice while administrating injection and disposal of the disposables. Health facilities were also observed to asses necessary equipments of safe injection and waste disposal methods. Among the health workers 93.3% ANM and 100% NS took sterile syringe from sterile unopened packet, all of the study subjects washed hand before giving injection, 13.3% of ANMs and 8% of NS are fully vaccinated against Hep B, 53.3% of ANM and all NS are practices non recapping. Only 13.33% sub centres along with PHC & BPHC had at least one puncture resistant leak proof container, 86.7% sub centres, PHC are free from loose needles. Transport for off side treatment is the method of waste disposal in case of 73.3% cases sub centres, PHC & BPHC. There is need to educate, train and motivate service providers in proper methods of giving injection along with improve the adequacy of supply of required equipments.

What is occupational therapy’s role in addressing sleep problems among older adults?

PubMed Central

Leland, Natalie E.; Marcione, Nicole; Niemiec, Stacey L. Schepens; Don Fogelberg, Kaivalya Kelkar

2014-01-01

Sleep problems, prevalent among older adults, are associated with poor outcomes and high healthcare costs. In 2008, rest and sleep became its own area of occupation in the AOTA Occupational Therapy Practice Framework. This scoping review examined a broad context of sleep research in order to highlight efficacious interventions for older adults that fall within the occupational therapy scope of practice and present an agenda for research and practice. Four sleep intervention areas clearly aligned with the Practice Framework, including cognitive behavioral therapy for insomnia, physical activity, and multi-component interventions. Occupational therapy is primed to address sleep problems by targeting the context and environment, performance patterns, and limited engagement in evening activities that may contribute to poor sleep. Occupational therapy researchers and clinicians need to work collaboratively to establish the evidence-base for occupation-centered sleep interventions in order to improve the health and quality of life of the older adult. PMID:24844879

Parent-infant co-sleeping and its relationship to breastfeeding.

PubMed

Buswell, Stephanie D; Spatz, Diane L

2007-01-01

Co-sleeping can provide numerous benefits for both the parent(s) and the infant. Perhaps the greatest advantage lies in its promotion of breastfeeding, an act widely recognized for its benefits to both the mother and infant. However, risks also are associated with co-sleeping, prompting many researchers to examine the safety of its practice. Pediatric nurse practitioners need to be informed on issues related to co-sleeping in order to educate parents regarding its risks and benefits, to assess the safety of an established sleeping environment, and to be aware of its prevalence in their patient populations. A review of the literature is presented to inform pediatric nurse practitioners about varied definitions of co-sleeping, the reasons why some parents engage in the practice, cultural preferences for co-sleeping, associated risks and benefits, and its relationship to breastfeeding.

Managing sleep and wakefulness in a 24-hour world

PubMed Central

Coveney, Catherine M

2014-01-01

This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work–social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns. PMID:23957268

Assessment and Management of Sleep Disturbance in Cirrhosis.

PubMed

Formentin, Chiara; Garrido, Maria; Montagnese, Sara

2018-01-01

This review presents an in-depth overview of the sleep-wake phenotype of patients with cirrhosis, together with available pharmacological and non-pharmacological treatment strategies. A set of simple, practical recommendations is also provided. The understanding of the pathophysiology of sleep disorders in this patient population has improved over the past decade, especially in relation to the interplay between homeostatic and circadian sleep regulation. In addition, new tools have been utilised for both screening and in-depth investigation of the sleep-wake profile of these patients. Finally, a number of studies have evaluated the efficacy of novel treatment strategies, often with encouraging results. Since sleep disturbances are common in patients with cirrhosis, more so than in patients with other chronic diseases of similar severity, their assessment should become routine hepatological practice, along with the initiation of adequate treatment.

Feeding Students in School: Providing Guidelines and Information on Safe Feeding Practices for Special Students.

ERIC Educational Resources Information Center

Hall, Sandra; And Others

This manual provides guidelines for safe feeding practices for students with disabilities in Oregon schools. Stressed is the importance of distinguishing between feeding for the maintenance of health and feeding for the acquisition of skills. Individual sections cover: definitions of feeding programs; the school district responsibility; risks;…

Sleep and Recovery in Team Sport: Current Sleep-Related Issues Facing Professional Team-Sport Athletes.

PubMed

Fullagar, Hugh H K; Duffield, Rob; Skorski, Sabrina; Coutts, Aaron J; Julian, Ross; Meyer, Tim

2015-11-01

While the effects of sleep loss on performance have previously been reviewed, the effects of disturbed sleep on recovery after exercise are less reported. Specifically, the interaction between sleep and physiological and psychological recovery in team-sport athletes is not well understood. Accordingly, the aim of the current review was to examine the current evidence on the potential role sleep may play in postexercise recovery, with a tailored focus on professional team-sport athletes. Recent studies show that team-sport athletes are at high risk of poor sleep during and after competition. Although limited published data are available, these athletes also appear particularly susceptible to reductions in both sleep quality and sleep duration after night competition and periods of heavy training. However, studies examining the relationship between sleep and recovery in such situations are lacking. Indeed, further observational sleep studies in team-sport athletes are required to confirm these concerns. Naps, sleep extension, and sleep-hygiene practices appear advantageous to performance; however, future proof-of-concept studies are now required to determine the efficacy of these interventions on postexercise recovery. Moreover, more research is required to understand how sleep interacts with numerous recovery responses in team-sport environments. This is pertinent given the regularity with which these teams encounter challenging scenarios during the course of a season. Therefore, this review examines the factors that compromise sleep during a season and after competition and discusses strategies that may help improve sleep in team-sport athletes.

Development and Validation of the PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment Item Banks.

PubMed

Forrest, Christopher B; Meltzer, Lisa J; Marcus, Carole L; de la Motte, Anna; Kratchman, Amy; Buysse, Daniel J; Pilkonis, Paul A; Becker, Brandon D; Bevans, Katherine B

2018-03-13

To develop and evaluate the measurement properties of child-report and parent-proxy versions of the PROMIS ® Pediatric Sleep Disturbance and Sleep-Related Impairment item banks. A national sample of 1,104 children (8-17 years-old) and 1,477 parents of children 5-17 years-old was recruited from an internet panel to evaluate the psychometric properties of 43 sleep health items. A convenience sample of children and parents recruited from a pediatric sleep clinic was obtained to provide evidence of the measures' validity; polysomnography data were collected from a subgroup of these children. Factor analyses suggested two dimensions: sleep disturbance and daytime sleep-related impairment. The final item banks included 15 items for Sleep Disturbance and 13 for Sleep-Related Impairment. Items were calibrated using the graded response model from item response theory. Of the 28 items, 16 are included in the parallel PROMIS adult sleep health measures. Reliability of the measures exceeded 0.90. Validity was supported by correlations with existing measures of pediatric sleep health and higher sleep disturbance and sleep-related impairment scores for children with sleep problems and those with chronic and neurodevelopmental disorders. The sleep health measures were not correlated with results from polysomnography. The PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment item banks provide subjective assessments of a child's difficulties falling and staying asleep as well as daytime sleepiness and its impact on functioning. They may prove useful in the future for clinical research and practice. Future research should evaluate their responsiveness to clinical change in diverse patient populations.

Implementation of the American Academy of Pediatrics recommendations to reduce sudden infant death syndrome risk in neonatal intensive care units: An evaluation of nursing knowledge and practice.

PubMed

Grazel, Regina; Phalen, Ann Gibbons; Polomano, Rosemary C

2010-12-01

There is a direct relationship between nonsupine sleeping and sudden infant death syndrome (SIDS). Premature infants are at greater risk for SIDS and are often cared for in nonsupine positions during the course of hospitalization. Healthy premature infants should be placed supine for sleep before discharge from the neonatal intensive care unit (NICU), and parents receive specific instruction about infant sleep position and other risk factors for SIDS. Most published literature addressing nursing practices for SIDS reduction reflects practices with the healthy newborn population. To examine and describe NICU nurses' knowledge of SIDS risk-reduction measures, modeling of safe infant sleep interventions prior to discharge, and inclusion of SIDS risk reduction in parent education. Convenience sample of nurses practicing in level II and III NICUs located in 2 Middle Atlantic States. A prospective survey design was used for the study. The 14-item questionnaire was developed by a team of neonatal clinical experts and distributed via site coordinators to nurses in 19 NICUs. A total of 1080 surveys were distributed and 430 (40%) NICU nurses completed the survey. The majority of nurses (85%) identified the American Academy of Pediatrics SIDS risk-reduction strategies for safe sleep. The investigators found that age, years of nursing and neonatal nursing experience, and educational preparation did not significantly contribute to the practice of "supine-only" position for sleep for infants in NICUs. The study revealed that nurses frequently position healthy preterm infants supine for sleep when weaned to an open crib (50%). Others wait one to a few days before discharge (15%) and some never position supine for sleep (6%). Stuffed toys are removed from cribs 90.5% of the time. For term infants without major medical complications, 45.5% of surveyed nurses continued to use positioning aids/rolls in infants' cribs. The most common reasons nurses cited to position preterm infants

Clinical Pharmacology in Sleep Medicine

PubMed Central

Proctor, Ashley; Bianchi, Matt T.

2012-01-01

The basic treatment goals of pharmacological therapies in sleep medicine are to improve waking function by either improving sleep or by increasing energy during wakefulness. Stimulants to improve waking function include amphetamine derivatives, modafinil, and caffeine. Sleep aids encompass several classes, from benzodiazepine hypnotics to over-the-counter antihistamines. Other medications used in sleep medicine include those initially used in other disorders, such as epilepsy, Parkinson's disease, and psychiatric disorders. As these medications are prescribed or encountered by providers in diverse fields of medicine, it is important to recognize the distribution of adverse effects, drug interaction profiles, metabolism, and cytochrome substrate activity. In this paper, we review the pharmacological armamentarium in the field of sleep medicine to provide a framework for risk-benefit considerations in clinical practice. PMID:23213564

Determining Resident Sleep During and After Call With Commercial Sleep Monitoring Devices.

PubMed

Morhardt, Duncan R; Luckenbaugh, Amy; Goldstein, Cathy; Faerber, Gary J

2017-08-01

To demonstrate that commercial activity monitoring devices (CAMDs) are practical for monitoring resident sleep while on call. Studies that have directly monitored resident sleep are limited, likely owing to both cost and difficulty in study interpretation. The advent of wearable CAMDs that estimate sleep presents the opportunity to more readily evaluate resident sleep in physically active settings and "home call," a coverage arrangement familiar to urology programs. Twelve urology residents were outfitted with Fitbit Flex devices during "home call" for a total of 57 (out of 64, or 89%) call or post-call night pairs. Residents were surveyed with the Stanford Sleepiness Scale (SSS), a single-question alertness survey. Time in bed (TIB) was "time to bed" to "rise for day." Fitbit accelerometers register activity as follows: (1) not moving; (2) minimal movement or restless; or (3) above threshold for accelerometer to register steps. Total sleep time (TST) was the number of minutes in level 1 activity during TIB. Sleep efficiency (SE) was defined as TST divided by TIB. While on call, 10 responding (of 12 available, 83%) residents on average reported TIB as 347 minutes, TST as 165 minutes, and had an SE of 47%. Interestingly, SSS responses did not correlate with sleep parameters. Post-call sleep demonstrated increases in TIB, SE, and TST (+23%, +15%, and +44%, respectively) while sleepiness was reduced by 22%. We demonstrate that urologic residents can consistently wear CAMDs while on home call. SSS did not correlate with Fitbit-estimated sleep duration. Further study with such devices may enhance sleep deprivation recognition to improve resident sleep. Copyright © 2017 Elsevier Inc. All rights reserved.

Treating the Sleep Disorders of Childhood: Current Practice in the United Kingdom

ERIC Educational Resources Information Center

Bartlet, L. B.

2006-01-01

Sleep disorders are common in childhood. Their prevalence is especially high in the presence of disability or chronic illness. They cause considerable stress to the children themselves and to their parents. Sleep deprivation leads to daytime behavioral problems and educational difficulties. In assessing sleep problems thorough history taking is…

Relationships among acculturative stress, sleep, and nondipping blood pressure in Korean American women.

PubMed

Suh, Minhee; Barksdale, Debra J; Logan, Jeongok

2013-02-01

Generally blood pressure (BP) should drop or dip by 10-20% during sleep. The phenomenon of nondipping BP during sleep has gained interest because of its association with various damaging effects to end-organs. This exploratory study examined nighttime nondipping BP, acculturative stress and quality of sleep in 30 Korean American women. Acculturative stress and sleep quality were measured using the Revised Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale (R-SAFE) and the Pittsburg Sleep Quality Index (PSQI), respectively. Participants' BP was monitored over a 24-hour period. Participants were categorized as dippers and nondippers based on the drop in nocturnal systolic BP. Of the 30 women, 8 (26.7%) were nondippers. A shorter sleep duration and more disturbed sleep were associated with nondipping and, interestingly, less acculturative stress was also associated with nondipping BP. Our finding supports that sleep evaluation is needed in caring for individuals with nondipping BP.

Making abortions safe: a matter of good public health policy and practice.

PubMed Central

Berer, M.

2000-01-01

Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. PMID:10859852

[Use of valerian in anxiety and sleep disorders: what is the best evidence?].

PubMed

Nunes, Ana; Sousa, Marlene

2011-12-01

Anxiety disorders and sleep problems are common in the general population and are a cause of frequent consultations in primary care. These problems have significant impact on quality of life and functionality of individuals. The extracts of valerian root have been widely used for a long time by the population and physicians, for their sedative effects, hypnotic and anxiolytic. It is therefore urgent to know what are the benefits and the risks of using this substance for the treatment of anxiety and sleep disorders. To investigate the efficacy and safety of valerian for the treatment of anxiety and sleep disorders. A research was carried out for clinical practice guidelines, systematic reviews (SR), meta-analysis (MA) and randomized controlled trials (RCT) in Pubmed, sites of evidence-based medicine and Índex das Revistas Médicas Portuguesas using the MeSH terms valerian, anxiety and sleep disorders, and respective DeCS, analyzing articles in English, Spanish, French or Portuguese, published between January 2000 and March 31, 2010. We also reviewed references of relevant articles. We used the Strength of Recommendation Taxonomy (SORT) from American Family Physician to evaluate the level of evidence and assigning the strength of a recommendation. We found 173 articles of which four were selected which met the inclusion criteria: a meta-analysis, a SR and a RCT concerning the use of valerian in sleep disorders, and an SR on the use of valerian in anxiety disorders. The evidence is insufficient regarding the efficacy of valerian in the treatment of anxiety disorders (SOR A). There seems to be some evidence of the effectiveness of valerian for treating insomnia, which is limited by the quality of existing studies (SOR B). Valerian root is well tolerated and safe, with infrequent and benign side effects (SOR A). The evidence is currently insufficient to recommend the use of valerian for the treatment of anxiety disorders. The evidence in insomnia is limited by the

Aspects of sleep disorders in children and adolescents

PubMed Central

Stores, Gregory

2009-01-01

Sleep disorders in children and adolescents is a topic that has been, and remains, neglected in both public health education and professional training. Although much knowledge has been accumulated in recent times, it has been poorly disseminated and, therefore, relatively little is put into practice. Only some general issues can be discussed in this article. The aspects chosen relate mainly to clinical practice, but they also have relevance for research. They concern various differences between sleep disorders in children and those in adults, the occurrence of such disorders in young people, their effects on psychological and physical development, the essential (but often ignored) distinction between sleep problems and their underlying causes (ie, sleep disorders), types of sleep disturbance encountered at different ages during development, and the differential diagnosis of certain parasomnias that are at particular risk of being confused with each other. PMID:19432390

Deprivation and Recovery of Sleep in Succession Enhances Reflexive Motor Behavior

PubMed Central

Sprenger, Andreas; Weber, Frederik D.; Machner, Bjoern; Talamo, Silke; Scheffelmeier, Sabine; Bethke, Judith; Helmchen, Christoph; Gais, Steffen; Kimmig, Hubert; Born, Jan

2015-01-01

Sleep deprivation impairs inhibitory control over reflexive behavior, and this impairment is commonly assumed to dissipate after recovery sleep. Contrary to this belief, here we show that fast reflexive behaviors, when practiced during sleep deprivation, is consolidated across recovery sleep and, thereby, becomes preserved. As a model for the study of sleep effects on prefrontal cortex-mediated inhibitory control in humans, we examined reflexive saccadic eye movements (express saccades), as well as speeded 2-choice finger motor responses. Different groups of subjects were trained on a standard prosaccade gap paradigm before periods of nocturnal sleep and sleep deprivation. Saccade performance was retested in the next morning and again 24 h later. The rate of express saccades was not affected by sleep after training, but slightly increased after sleep deprivation. Surprisingly, this increase augmented even further after recovery sleep and was still present 4 weeks later. Additional experiments revealed that the short testing after sleep deprivation was sufficient to increase express saccades across recovery sleep. An increase in speeded responses across recovery sleep was likewise found for finger motor responses. Our findings indicate that recovery sleep can consolidate motor disinhibition for behaviors practiced during prior sleep deprivation, thereby persistently enhancing response automatization. PMID:26048955

Deprivation and Recovery of Sleep in Succession Enhances Reflexive Motor Behavior.

PubMed

Sprenger, Andreas; Weber, Frederik D; Machner, Bjoern; Talamo, Silke; Scheffelmeier, Sabine; Bethke, Judith; Helmchen, Christoph; Gais, Steffen; Kimmig, Hubert; Born, Jan

2015-11-01

Sleep deprivation impairs inhibitory control over reflexive behavior, and this impairment is commonly assumed to dissipate after recovery sleep. Contrary to this belief, here we show that fast reflexive behaviors, when practiced during sleep deprivation, is consolidated across recovery sleep and, thereby, becomes preserved. As a model for the study of sleep effects on prefrontal cortex-mediated inhibitory control in humans, we examined reflexive saccadic eye movements (express saccades), as well as speeded 2-choice finger motor responses. Different groups of subjects were trained on a standard prosaccade gap paradigm before periods of nocturnal sleep and sleep deprivation. Saccade performance was retested in the next morning and again 24 h later. The rate of express saccades was not affected by sleep after training, but slightly increased after sleep deprivation. Surprisingly, this increase augmented even further after recovery sleep and was still present 4 weeks later. Additional experiments revealed that the short testing after sleep deprivation was sufficient to increase express saccades across recovery sleep. An increase in speeded responses across recovery sleep was likewise found for finger motor responses. Our findings indicate that recovery sleep can consolidate motor disinhibition for behaviors practiced during prior sleep deprivation, thereby persistently enhancing response automatization. © The Author 2015. Published by Oxford University Press.

Varying influences of motivation factors on employees' likelihood to perform safe food handling practices because of demographic differences.

PubMed

Ellis, Jason D; Arendt, Susan W; Strohbehn, Catherine H; Meyer, Janell; Paez, Paola

2010-11-01

Food safety training has been the primary avenue for ensuring food workers are performing proper food handling practices and thus, serving safe food. Yet, knowledge of safe food handling practices does not necessarily result in actual performance of these practices. This research identified participating food service employees' level of agreement with four factors of motivation (internal motivations, communication, reward-punishment, and resources) and determined if respondents with different demographic characteristics reported different motivating factors. Data were collected from 311 food service employees who did not have any supervisory responsibilities. Intrinsic motivation agreement scores were consistently the highest of all four motivational factors evaluated and did not differ across any of the demographic characteristics considered. In contrast, motivation agreement scores for communication, reward-punishment, and resources did differ based on respondents' gender, age, place of employment, job status, food service experience, completion of food handler course, or possession of a food safety certification. In general, respondents agreed that these motivation factors influenced their likelihood to perform various safe food handling procedures. This research begins to illustrate how employees' demographic characteristics influence their responses to various motivators, helping to clarify the complex situation of ensuring safe food in retail establishments. Future research into why employee willingness to perform varies more for extrinsic motivation than for intrinsic motivation could assist food service managers in structuring employee development programs and the work environment, in a manner that aids in improving external motivation (communication, reward-punishment, and resources) and capitalizing on internal motivation.

Managing sleep and wakefulness in a 24-hour world.

PubMed

Coveney, Catherine M

2014-01-01

This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work-social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial

PubMed Central

Lillehei, Angela Smith; Savik, Kay; Reis, Reilly

2015-01-01

Abstract Objectives: To compare the effectiveness of lavender (Lavandula angustifolia) and sleep hygiene versus sleep hygiene alone on sleep quantity and sleep quality and to determine sustained effect at two-week follow-up. Design: A randomized controlled trial with investigator blinding and steps taken to blind the participants. Setting: Participants' usual sleep setting. Subjects: Seventy-nine college students with self-reported sleep issues. Interventions: The intervention took place over five nights with baseline, postintervention, and two-week follow-up assessments. Both groups practiced good sleep hygiene and wore an inhalation patch on their chest at night. One group wore a patch with 55 μl of lavender essential oil and the other group wore a blank patch. Outcome measures: Sleep quantity was measured using a Fitbit® tracker and a sleep diary, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form. Results: The lavender and sleep hygiene group demonstrated better sleep quality at postintervention and two-week follow-up (PSQI p=0 .01, <0.001 and PROMIS p=0.04, 0.007, respectively). The sleep-hygiene-only group also demonstrated better sleep quality but to a lesser extent (PSQI p=0.02, 0.06 and PROMIS p=0.03, 0.03, respectively). Additionally, a clinical effect was found for the lavender group at postintervention, along with a significant finding for waking feeling refreshed (p=0.01). Sleep quantity did not differ between groups. Conclusions: Lavender and sleep hygiene together, and sleep hygiene alone to a lesser degree, improved sleep quality for college students with self-reported sleep issues, with an effect remaining at follow-up. PMID:26133206

Sleep Restriction Therapy and Hypnotic Withdrawal versus Sleep Hygiene Education in Hypnotic Using Patients with Insomnia

PubMed Central

Taylor, Daniel J.; Schmidt-Nowara, Wolfgang; Jessop, Carol A.; Ahearn, John

2010-01-01

Study Objectives: Insomnia is a common problem that affects 9% to 15% of the population chronically. The primary objective of this study was to demonstrate that 8 weekly sessions of sleep restriction therapy of insomnia combined with hypnotic reduction instructions following a single session of sleep hygiene education would result in greater improvements in sleep and hypnotic use than sleep hygiene education alone. Methods: Forty-six men and women were recruited from a sleep medicine practice and randomly assigned to sleep hygiene education plus 8 weeks of sleep restriction and hypnotic withdrawal (SR+HW; n = 24), or a sleep hygiene education alone (SHE; n = 22) condition. Pre-randomization, all patients received a single session of instruction in good sleep habits (sleep hygiene education). Results: The SR+HW condition had greater improvements in hypnotic medication usage, sleep onset latency, morning wake time, sleep efficiency, and wake time after sleep onset (trend), than the SHE condition. Continued improvement was seen in TST in the SR+HW group at 6-month follow-up, and gains on all other variables were maintained at 6- and 12-month follow-up. Conclusions: These results provide evidence that more intensive treatment of insomnia (i.e., 8 sessions of SR+HW plus hypnotic withdrawal instructions) results in better outcomes than SHE alone. Citation: Taylor DJ; Schmidt-Nowara W; Jessop CA; Ahearn J. Sleep restriction therapy and hypnotic withdrawal versus sleep hygiene education in hypnotic using patients with insomnia. J Clin Sleep Med 2010;6(2):169-175. PMID:20411695

Training issues pertaining to sleep medicine and child neurology.

PubMed

Kotagal, Suresh

2011-06-01

Co-morbid sleep disorders are quite common in Child Neurology. Formal training in the field of sleep medicine and routine attention to sleep-wake function in clinical practice enhances the ability of the child neurologist to deliver comprehensive care. Copyright © 2011 Elsevier Inc. All rights reserved.

Effect of Sleep Hygiene Education on Sleep Quality in Hemodialysis Patients

PubMed Central

Soleimani, Farzaneh; Hasanpour-Dehkordi, Ali

2016-01-01

Introduction Sleep is referred a regular, recurring and easily revocable state of organism which is characterized by relative immobility and significant increase in response threshold to environmental stimuli. Sleep disorders are common among haemodialysis patients. Aim The aim of this study was to investigate the effect of sleep hygiene education on sleep quality in haemodialysis patients. Materials and Methods This study is a randomized controlled clinical trial. The participants of this study were 60 haemodialysis patients admitted to the Dialysis Center of Shahid Ayatollah Madani Hospital of Khoy, affiliated with the Urmia University of Medical Sciences. Sampling was done randomly and the partcipants were randomly divided into intervention group (30 patients) and control group (30 patients). Sleep quality of participants was measured before and after the intervention by Pittsburgh Sleep Quality Index (PSQI). Training process for sleep hygiene behaviours was presented to the participants face-to-face. The data were analysed using SPSS 16. Results A significant difference in the mean (standard deviation) score for PSQI (p<0.001) was observed before and after intervention in the intervention group, while in the control group, the difference was not significant (p=0.704), In addition, a significant difference was observed in the mean (standard deviation) score for PSQI between the two, intervention and control groups after the educational intervention (p=0.034). Conclusion Sleep hygiene education, alongside other appro-aches, is a low-cost, accessible and practical method which can be implemented within a short period of time. PMID:28208884

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

PubMed Central

Ramar, Kannan; Dort, Leslie C.; Katz, Sheri G.; Lettieri, Christopher J.; Harrod, Christopher G.; Thomas, Sherene M.; Chervin, Ronald D.

2015-01-01

to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits— as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations. Citation: Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11(7):773–827. PMID:26094920

Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study.

PubMed

Pease, Anna; Ingram, Jenny; Blair, Peter S; Fleming, Peter J

2017-01-01

Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. Factors influencing mothers' adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of 'do's' and 'don'ts' was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers' own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change.

Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study

PubMed Central

Ingram, Jenny; Blair, Peter S; Fleming, Peter J

2017-01-01

Objective Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. Design and setting Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. Participants Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. Results Factors influencing mothers’ adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. Conclusions Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of ‘do’s’ and ‘don’ts’ was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers’ own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be

Sleep: An Open-Source Python Software for Visualization, Analysis, and Staging of Sleep Data

PubMed Central

Combrisson, Etienne; Vallat, Raphael; Eichenlaub, Jean-Baptiste; O'Reilly, Christian; Lajnef, Tarek; Guillot, Aymeric; Ruby, Perrine M.; Jerbi, Karim

2017-01-01

We introduce Sleep, a new Python open-source graphical user interface (GUI) dedicated to visualization, scoring and analyses of sleep data. Among its most prominent features are: (1) Dynamic display of polysomnographic data, spectrogram, hypnogram and topographic maps with several customizable parameters, (2) Implementation of several automatic detection of sleep features such as spindles, K-complexes, slow waves, and rapid eye movements (REM), (3) Implementation of practical signal processing tools such as re-referencing or filtering, and (4) Display of main descriptive statistics including publication-ready tables and figures. The software package supports loading and reading raw EEG data from standard file formats such as European Data Format, in addition to a range of commercial data formats. Most importantly, Sleep is built on top of the VisPy library, which provides GPU-based fast and high-level visualization. As a result, it is capable of efficiently handling and displaying large sleep datasets. Sleep is freely available (http://visbrain.org/sleep) and comes with sample datasets and an extensive documentation. Novel functionalities will continue to be added and open-science community efforts are expected to enhance the capacities of this module. PMID:28983246

Sleep: An Open-Source Python Software for Visualization, Analysis, and Staging of Sleep Data.

PubMed

Combrisson, Etienne; Vallat, Raphael; Eichenlaub, Jean-Baptiste; O'Reilly, Christian; Lajnef, Tarek; Guillot, Aymeric; Ruby, Perrine M; Jerbi, Karim

2017-01-01

We introduce Sleep, a new Python open-source graphical user interface (GUI) dedicated to visualization, scoring and analyses of sleep data. Among its most prominent features are: (1) Dynamic display of polysomnographic data, spectrogram, hypnogram and topographic maps with several customizable parameters, (2) Implementation of several automatic detection of sleep features such as spindles, K-complexes, slow waves, and rapid eye movements (REM), (3) Implementation of practical signal processing tools such as re-referencing or filtering, and (4) Display of main descriptive statistics including publication-ready tables and figures. The software package supports loading and reading raw EEG data from standard file formats such as European Data Format, in addition to a range of commercial data formats. Most importantly, Sleep is built on top of the VisPy library, which provides GPU-based fast and high-level visualization. As a result, it is capable of efficiently handling and displaying large sleep datasets. Sleep is freely available (http://visbrain.org/sleep) and comes with sample datasets and an extensive documentation. Novel functionalities will continue to be added and open-science community efforts are expected to enhance the capacities of this module.

Safe patient handling perceptions and practices: a survey of acute care physical therapists.

PubMed

Olkowski, Brian F; Stolfi, Angela M

2014-05-01

Acute care physical therapists are at risk for developing work-related musculoskeletal disorders (WMSDs) due to manual patient handling. Safe patient handling (SPH) reduces WMSDs caused by manual handling. The purpose of this study was to describe the patient handling practices of acute care physical therapists and their perceptions regarding SPH. Additionally, this study determined whether an SPH program influences the patient handling practices and perceptions regarding SPH of acute care physical therapists. Subscribers to the electronic discussion board of American Physical Therapy Association's Acute Care Section were invited to complete a survey questionnaire. The majority of respondents used SPH equipment and practices (91.1%), were confident using SPH equipment and practices (93.8%), agreed that evidence supports the use of SPH equipment and practices (87.0%), and reported the use of SPH equipment and practices is feasible (92.2%). Respondents at a facility with an SPH program were more likely to use SPH equipment and practices, have received training in the use of SPH equipment and practices, agree that the use of SPH equipment and practices is feasible, and feel confident using SPH equipment and practices. The study might not reflect the perceptions and practices of the population of acute care physical therapists. Acute care physical therapists are trained to use SPH equipment and practices, use SPH equipment and practices, and have positive perceptions regarding SPH. Acute care physical therapists in a facility with an SPH program are more likely to use SPH equipment and practices, receive training in SPH equipment and practices, and have positive perceptions regarding SPH. Quasi-regulatory organizations should incorporate SPH programs into their evaluative standards.

Understanding women's sleep management: beyond medicalization-healthicization?

PubMed

Hislop, Jenny; Arber, Sara

2003-11-01

This paper addresses sleep, which to date has been a neglected area within the sociology of health and illness. We explore the extent to which the concepts of medicalization and healthicization provide appropriate models for understanding the management of women's sleep disruption. The prescription of sleeping pills remains as an indicator of the medicalization of sleep, while the trend towards the healthicization of sleep as part of healthy lifestyle practice is reflected in the increased focus of the media, pharmaceutical and complementary health care industries on sleep. The paper analyses qualitative data on women aged 40 and over to argue that the medicalization-healthicization framework fails to encapsulate a complete understanding of how women manage sleep disruption within the social context of their lives. It suggests that by looking inside the world of women's sleep we uncover a hidden dimension of self-directed personalized activity which plays a key role in women's response to sleep disruption. We propose an alternative model for the management of women's sleep which incorporates a core of personalised activity, linked to strategies associated with healthicization and medicalization.

Adolescent Problematic Social Networking and School Experiences: The Mediating Effects of Sleep Disruptions and Sleep Quality.

PubMed

Vernon, Lynette; Barber, Bonnie L; Modecki, Kathryn L

2015-07-01

An important developmental task for adolescents is to become increasingly responsible for their own health behaviors. Establishing healthy sleep routines and controlling media use before bedtime are important for adequate, quality sleep so adolescents are alert during the day and perform well at school. Despite the prevalence of adolescent social media use and the large percentage of computers and cell phones in adolescents' bedrooms, no studies to date have investigated the link between problematic adolescent investment in social networking, their sleep practices, and associated experiences at school. A sample of 1,886 students in Australia aged between 12 and 18 years of age completed self-report data on problematic social networking use, sleep disturbances, sleep quality, and school satisfaction. Structural equation modeling (SEM) substantiated the serial mediation hypothesis: for adolescents, problematic social networking use significantly increased sleep disturbances, which adversely affected perceptions of sleep quality that, in turn, lowered adolescents' appraisals of their school satisfaction. This significant pattern was largely driven by the indirect effect of sleep disturbances. These findings suggest that adolescents are vulnerable to negative consequences from social networking use. Specifically, problematic social networking is associated with poor school experiences, which result from poor sleep habits. Promoting better sleep routines by minimizing sleep disturbances from social media use could improve school experiences for adolescents with enhanced emotional engagement and improved subjective well-being.

Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls.

PubMed

van der Heijden, K B; Stoffelsen, R J; Popma, A; Swaab, H

2018-01-01

Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6-12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed.

Hypnosis Intervention Effects on Sleep Outcomes: A Systematic Review.

PubMed

Chamine, Irina; Atchley, Rachel; Oken, Barry S

2018-02-15

Sleep improvement is a promising target for preventing and modifying many health problems. Hypnosis is considered a cost-effective and safe intervention with reported benefits for multiple health conditions. There is a growing body of research assessing the efficacy of hypnosis for various health conditions in which sleep was targeted as a primary or secondary outcome. This review aimed to investigate the effects of hypnosis interventions on sleep, to describe the hypnotic procedures, and to evaluate potential adverse effects of hypnosis. We reviewed studies (prior to January 2017) using hypnosis in adults for sleep problems and other conditions comorbid with sleep problems, with at least one sleep outcome measure. Randomized controlled trials and other prospective studies were included. One hundred thirty-nine nonduplicate abstracts were screened, and 24 of the reviewed papers were included for qualitative analysis. Overall, 58.3% of the included studies reported hypnosis benefit on sleep outcomes, with 12.5% reporting mixed results, and 29.2% reporting no hypnosis benefit; when only studies with lower risk of bias were reviewed the patterns were similar. Hypnosis intervention procedures were summarized and incidence of adverse experiences assessed. Hypnosis for sleep problems is a promising treatment that merits further investigation. Available evidence suggests low incidence of adverse events. The current evidence is limited because of few studies assessing populations with sleep complaints, small samples, and low methodological quality of the included studies. Our review points out some beneficial hypnosis effects on sleep but more high-quality studies on this topic are warranted. © 2018 American Academy of Sleep Medicine

[Preparation and effect of a behavioral science-based education program for sleep improvement among medical students].

PubMed

Ueda, Masumi; Adachi, Yoshiko; Hayama, Junko; Yamagami, Toshiko

2008-01-01

The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed. Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture. It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement

[Safe school].

PubMed

Liberal, Edson Ferreira; Aires, Roberto Tschoepke; Aires, Mariana Tschoepke; Osório, Ana Carla de Albuquerque

2005-11-01

To review the strategies to make school a safe environment. The paper first addresses the social context of accidents and violence in the school environment, and makes recommendations, based on the literature data, for the implementation of safe schools. Articles published between 1993 and 2005 in the MEDLINE database. Brazilian epidemiological and literature data have also been searched. There is growing evidence that intervention has multiple components, focusing on health education practices, with the participation of the whole community. The aim of those interventions is to help students and community members to adopt healthy and safe behaviors. Schools are taking on an increasing role in health promotion, disease prevention, and injury prevention. In the context of prevention of external causes of morbidity and mortality, it is important to recognize a risky environment, places, and risk behaviors as favorable to injury and violence, as well as the concept of accident as something one can avoid. Implementation of safe schools represents a promising new direction for school-based preventive work. It is important to note that a safe school should intervene not only in its physical structure, but it should also make it as safe as possible by gathering the school community through health education, and mainly encouraging healthy behavior.

Quality assessment of osteoporosis clinical practice guidelines for physical activity and safe movement: an AGREE II appraisal.

PubMed

Armstrong, James Jacob; Rodrigues, Isabel Braganca; Wasiuta, Tom; MacDermid, Joy C

2016-01-01

Many osteoporosis clinical practice guidelines are published, and the extent to which physical activity and safe movement is addressed varies. To better inform clinical decision-making, a quality assessment and structured analysis of recommendations was undertaken. Guideline quality varied substantially, and improvement is necessary in physical activity and safe movement recommendations. The purpose of the present study is to survey available osteoporosis clinical practice guidelines (CPGs) containing physical activity and safe movement recommendations in order to assess the methodological quality with which they were developed. An analysis of the various physical activity and safe movement recommendations was conducted to determine variability between CPGs. An online literature search revealed 19 CPGs meeting our inclusion criteria. Three independent scorers evaluated CPG quality using the Appraisal of Guidelines for Research and Evaluation version II (AGREE II) instrument. Two separate individuals used a standard table to extract relevant recommendations. Intra-reviewer AGREE II score agreement ranged from fair to good (intra-class correlation coefficient (ICC) = 0.34 to 0.65). The quality of the 19 included CPGs was variable (AGREE sub-scores: 14 to 100%). CPGs scored higher in the "scope and purpose" and "clarity of presentation" domains. They scored the lowest in "applicability" and "editorial independence." Four CPGs were classified as high quality, ten average quality, and five low quality. Most CPGs recommended weight-bearing, muscle-strengthening, and resistance exercises. Information on exercise dosage, progression, and contraindications was often absent. Immobility and movements involving spinal flexion and/or torsion were discouraged. There were several high-quality CPGs; however, variability in quality and lack of specific parameters for implementation necessitates caution and critical examination by readers. CPG development groups should pay

16 CFR 312.11 - Safe harbor programs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Safe harbor programs. 312.11 Section 312.11 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.11 Safe harbor programs. (a) In general. Industry groups or other persons...

Level of awareness of cervical and breast cancer risk factors and safe practices among college teachers of different states in india: do awareness programmes have an impact on adoption of safe practices?

PubMed

Shankar, Abhishek; Rath, Gk; Roy, Shubham; Malik, Abhidha; Bhandari, Ruchir; Kishor, Kunal; Barnwal, Keshav; Upadyaya, Sneha; Srivastava, Vivek; Singh, Rajan

2015-01-01

Breast and cervical cancers are the most common causes of cancer mortality among women in India, but actually they are largely preventable diseases. Although early detection is the only way to reduce morbidity and mortality, there are limited data on breast and cervical cancer knowledge, safe practices and attitudes of teachers in India. The purpose of this study is to assess the level of awareness and impact of awareness programs in adoption of safe practices in prevention and early detection. This assessment was part of a pink chain campaign on cancer awareness. During cancer awareness events in 2011 at various women colleges in different parts in India, a pre-test related to cervical cancer and breast cancer was followed by an awareness program. Post-tests using the same questionnaire were conducted at the end of the interactive session, at 6 months and 1 year. A total of 156 out of 182 teachers participated in the study (overall response rate was 85.7 %). Mean age of the study population was 42.4 years (range- 28-59 yrs). There was a significant increase in level of knowledge regarding cervical and breast cancer at 6 months and this was sustained at 1 year. Adoption of breast self examination (BSE) was significantly more frequent in comparison to CBE, mammography and the Pap test. Magazines and newspapers were sources for knowledge regarding screening tests for breast cancer in more than 60% of teachers where as more than 75% were educated by doctors regarding the Pap test. Post awareness at 6 months and 1 year, there was a significant change in alcohol and smoking habits. Major reasons for not doing screening test were found to be ignorance (50%), lethargic attitude (44.8%) and lack of time (34.6%). Level of knowledge of breast cancer risk factors, symptoms and screening methods was high as compared to cervical cancer. There was a significant increase in level of knowledge regarding cervical and breast cancer at 6 months and this was sustained at 1 year

Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network

PubMed Central

Redline, Susan; Baker-Goodwin, Si; Bakker, Jessie P.; Epstein, Matthew; Hanes, Sherry; Hanson, Mark; Harrington, Zinta; Johnston, James C.; Kapur, Vishesh K.; Keepnews, David; Kontos, Emily; Lowe, Andy; Owens, Judith; Page, Kathy; Rothstein, Nancy

2016-01-01

Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient “researchers” are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the “customer.” To date, however, the “patient voice” largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care. Citation: Redline S, Baker-Goodwin S, Bakker JP, Epstein M, Hanes S, Hanson M, Harrington Z, Johnston JC, Kapur VK, Keepnews D, Kontos E, Lowe A, Owens J, Page K, Rothstein N, Sleep Apnea Patient-Centered Outcomes Network. Patient partnerships transforming sleep medicine research and clinical care: perspectives from the Sleep Apnea Patient-Centered Outcomes Network. J

The Lead-Safe Certified Guide to Renovate Right

MedlinePlus

... for information about courses and resources on lead-safe work practices. 1 RENOVAT ING, REPA IRING, OR PA ... child care facility or school. • Always use lead-safe work practices when renovation or repair will disturb painted ...

Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report.

PubMed

Morgenthaler, Timothy I; Aurora, R Nisha; Brown, Terry; Zak, Rochelle; Alessi, Cathy; Boehlecke, Brian; Chesson, Andrew L; Friedman, Leah; Kapur, Vishesh; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J

2008-01-01

These practice parameters are an update of the previously published recommendations regarding the use of autotitrating positive airway pressure (APAP) devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. Continuous positive airway pressure (CPAP) at an effective setting verified by attended polysomnography is a standard treatment for obstructive sleep apnea (OSA). APAP devices change the treatment pressure based on feedback from various patient measures such as airflow, pressure fluctuations, or measures of airway resistance. These devices may aid in the pressure titration process, address possible changes in pressure requirements throughout a given night and from night to night, aid in treatment of OSA when attended CPAP titration has not or cannot be accomplished, or improve patient comfort. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine has reviewed the literature published since the 2002 practice parameter on the use of APAP. Current recommendations follow: (1) APAP devices are not recommended to diagnose OSA; (2) patients with congestive heart failure, patients with significant lung disease such as chronic obstructive pulmonary disease; patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome); patients who do not snore (either naturally or as a result of palate surgery); and patients who have central sleep apnea syndromes are not currently candidates for APAP titration or treatment; (3) APAP devices are not currently recommended for split-night titration; (4) certain APAP devices may be used during attended titration with polysomnography to identify a single pressure for use with standard CPAP for treatment of moderate to severe OSA; (5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without

Factors associated with the teaching of sleep hygiene to patients in nursing students.

PubMed

Huang, Chiung-Yu; Liao, Hui-Yen; Chang, En-Ting; Lai, Hui-Ling

2018-01-01

Teaching patients about sleep hygiene is a common practice in nursing. This study investigated the relationships of nursing students' sleep quality, sleep knowledge, and attitudes toward sleep hygiene with the teaching of sleep hygiene to patients with sleep disorders. A descriptive correlational design was adopted to investigate 258 nursing students from 2 nursing schools in different regions of Taiwan. A series of self-developed and standardized questionnaires was used to collect data. Binary logistic regression analysis was used to identify the predictors of nursing students' teaching patients about sleep hygiene. The overall response rate was 92.8%. A total of 63.6% of the participants taught their patients about sleep hygiene. The findings reveal that the participants were generally less knowledgeable about sleep, particularly in the aspect of sleep hygiene. Those with higher sleep quality, more knowledge about sleep, and more positive attitudes toward sleep hygiene were more likely to teach their patients about sleep hygiene. Sleep quality, sleep knowledge, and attitudes toward sleep hygiene were independent predictors of nursing students' teaching patients about sleep hygiene. The study findings suggest that educators and clinical preceptors may develop effective strategies, such as relaxation, to improve nursing students' sleep quality and integrate sleep education into nursing curricula to further advance the students' sleep knowledge in educational programs and practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

A cognitive vulnerability model on sleep and mood in adolescents under naturalistically restricted and extended sleep opportunities.

PubMed

Bei, Bei; Wiley, Joshua F; Allen, Nicholas B; Trinder, John

2015-03-01

School terms and vacations represent naturally occurring periods of restricted and extended sleep opportunities. A cognitive model of the relationships among objective sleep, subjective sleep, and negative mood was tested across these periods, with sleep-specific (i.e., dysfunctional beliefs and attitudes about sleep) and global (i.e., dysfunctional attitudes) cognitive vulnerabilities as moderators. Longitudinal study over the last week of a school term (Time-E), the following 2-w vacation (Time-V), and the first week of the next term (Time-S). General community. 146 adolescents, 47.3% male, mean age =16.2 years (standard deviation +/- 1 year). N/A. Objective sleep was measured continuously by actigraphy. Sociodemographics and cognitive vulnerabilities were assessed at Time-E; subjective sleep, negative mood (anxiety and depressive symptoms), and academic stress were measured at each time point. Controlling for academic stress and sex, subjective sleep quality mediated the relationship between objective sleep and negative mood at all time points. During extended (Time-V), but not restricted (Time-E and Time-S) sleep opportunity, this mediation was moderated by global cognitive vulnerability, with the indirect effects stronger with higher vulnerability. Further, at Time-E and Time-V, but not Time-S, greater sleep-specific and global cognitive vulnerabilities were associated with poorer subjective sleep quality and mood, respectively. Results highlighted the importance of subjective sleep perception in the development of sleep related mood problems, and supported the role of cognitive vulnerabilities as potential mechanisms in the relationships between objective sleep, subjective sleep, and negative mood. Adolescents with higher cognitive vulnerability are more susceptible to perceived poor sleep and sleep related mood problems. These findings have practical implications for interventions. © 2015 Associated Professional Sleep Societies, LLC.

Early to Bed, Early to Rise?: An Exploration of Adolescent Sleep Hygiene Practices

ERIC Educational Resources Information Center

Malone, Susan Kohl

2011-01-01

Cognition, memory, safety, mental health, and weight are all affected by inadequate sleep. Biological studies indicate significant changes in sleep architecture during adolescence, such as changes in melatonin secretion, and a need for greater total sleep time. Yet, social contexts and cultural values impinge on these changing biological sleep…

Sleep: important considerations for the prevention of cardiovascular disease.

PubMed

Grandner, Michael A; Alfonso-Miller, Pamela; Fernandez-Mendoza, Julio; Shetty, Safal; Shenoy, Sundeep; Combs, Daniel

2016-09-01

Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities. Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.

Safe and secure. How to create an effective OSHA compliance program in your practice.

PubMed

Anderson, Douglas G

2007-08-01

Medical group practice administrators have a responsibility to provide a safe working environment for their employees and patients. You must create an effective Occupational Safety and Health Administration (OSHA) compliance program in your organization. The complexity and diversity of OSHA standards are significant, and developing an effective program requires more than a cut-and-paste approach. This article describes the scope of the task, the steps to take and tools you can use.

Sleep disorder risk factors among student athletes.

PubMed

Monma, Takafumi; Ando, Akira; Asanuma, Tohru; Yoshitake, Yutaka; Yoshida, Goichiro; Miyazawa, Taiki; Ebine, Naoyuki; Takeda, Satoko; Omi, Naomi; Satoh, Makoto; Tokuyama, Kumpei; Takeda, Fumi

2018-04-01

To clarify sleep disorder risk factors among student athletes, this study examined the relationship between lifestyle habits, competition activities, psychological distress, and sleep disorders. Student athletes (N = 906; male: 70.1%; average age: 19.1 ± 0.8 years) in five university sports departments from four Japanese regions were targeted for analysis. Survey items were attributes (age, gender, and body mass index), sleep disorders (recorded through the Pittsburgh Sleep Quality Index), lifestyle habits (bedtime, wake-up time, smoking, drinking alcohol, meals, part-time jobs, and use of electronics after lights out), competition activities (activity contents and competition stressors), and psychological distress (recorded through the K6 scale). The relation between lifestyle habits, competition activities, psychological distress, and sleep disorders was explored using logistic regression analysis. Results of multivariate logistic regression analysis with attributes as adjustment variables showed that "bedtime," "wake-up time," "psychological distress," "part-time jobs," "smartphone/cellphone use after lights out," "morning practices," and "motivation loss stressors," were risk factors that were independently related to sleep disorders. Sleep disorders among student athletes are related to lifestyle habits such as late bedtime, early wake-up time, late night part-time jobs, and use of smartphones/cellphones after lights out; psychological distress; and competition activities such as morning practices and motivation loss stressors related to competition. Therefore, this study suggests the importance of improving these lifestyle habits, mental health, and competition activities. Copyright © 2017 Elsevier B.V. All rights reserved.

Safe Schools: A Best Practices Guide

ERIC Educational Resources Information Center

Council of Educational Facility Planners International, 2013

2013-01-01

Every day in America more than 50 million children go to neighborhood public schools. Parents send them off with every hope they will be safe while there. And yet, as has been the case in too many cities, violence shatters that hope. The Council of Educational Facilities Planners International (CEFPI) seeks to lead in the effort to bolster schools…

Treatment of obstructive sleep apnea patients using oral appliances--our experiences.

PubMed

Miljus, Dusan; Tihacek-Sojić, Ljiljana; Milić-Lemić, Aleksandra; Andjelković, Marko

2014-07-01

Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders. It is recognized as a serious risk factor for car and workplace accidents due to daytime sleepiness, and factor for coronary heart diseases and stroke. The aim of this study was to examine the effectiveness of oral appliances for mandibular advance in treating mild to moderate OSA. A total of 15 patients were included in this study, all diagnosed with mild or moderate OSA. Oral appliances were custom made for each patient in protrusive position at 50% of maximum mandibular advancement. The patients were given instructions not to sleep on their backs and avoid alcohol consumption during the study as these are the factors that can contribute to symptoms progression. Complete and partial treatment success was achieve in 14 of the patients. Apnea-hypopnea index values were significantly lower (p < 0.05) at the end of a 6-month observation period compared to those at the treatment beginning. A great improvement in symptoms was observed, with daytime sleepiness index values significantly reduced already within the first month of the treatment. Treatment of obstructive sleep apnea with oral appliances has proven successful. Patients were comfortable using oral appliances and were ready to wear them for prolonged period of time. Use of oral appliances is very common in the world and should not be discarded. They are also very comfortable, practical and affordable comparing to continuous positive airway pressure (CPAP) apparatus, not to mention surgery. Use of oral appliances is safe and very well tolerated, and ought to be offered to patients with OSA.

Violations of safe diving practices among 122 diver fatalities.

PubMed

Shreeves, Karl; Buzzacott, Peter; Hornsby, Al; Caney, Mark

2018-01-01

Diving is a popular recreation with an excellent safety record, with an estimated 1.8 deaths per 1 million dives. This study investigated the relationship between intentional deviation from accepted diving practices (violations) and diver fatalities. The authors examined 119 incidents/122 diver fatalities that did not involve diver training in North America and the Caribbean, and identified the presence of violations of accepted diving safety practices, as well as if the death was associated with an acute medical event such as heart attack. Of the 122 fatalities, 57% (n = 70) were associated with a medical event and 43% (n = 52) were non-medical. Violations were found in 45% of fatalities (n = 55) overall. Violations were recorded for 23% of the 70 medical and 75% of the 52 non-medical fatalities. Divers who died from something other than a medical cause were 7 times as likely to have one or more violations associated with the fatality (OR 7.3, 95% CI 2.3-23.2). The odds of dying from something other than a medical condition increased approximately 60% for each additional 10 metres of depth. The odds of a death being associated with a medical condition increased approximately 9% per year of age, or 2.4 times for every 10 years older a diver was. Medical events are associated with over half of the non-training related diver fatalities in North America and the Caribbean, with the odds of death being associated with a medical condition doubling each decade of additional age. These data support recommendations that divers stay physically fit and have regular medical checkups, particularly as they get older. They also strongly support the safety benefit of adhering to established safe diving practices.

A comparison of sleep assessment tools by nurses and patients in critical care.

PubMed

Richardson, Annette; Crow, Wendy; Coghill, Elaine; Turnock, Christopher

2007-09-01

The aim of this critical care sleep assessment pilot study was to evaluate the usefulness of three sleep assessment tools to identify which, if any, provided the closest comparison between the nurses' judgement and the patients' experience of their sleep. The study objectives were to: (i) compare patients' and nurses' assessment of sleep using three different rating tools. (ii) Ascertain patients' preferences with non-interventional, user friendly, practical tools in critical care. (iii) Recommend changes and improvements to the way that sleep is assessed and documented. Sleep is important for promoting critical care recovery and sleep disturbance is known to cause irritability, aggression and increased stress levels. The availability and use of valid critical care sleep assessment tools is limited. A descriptive comparative study using three sleep assessment-rating scales were constructed to provide easy to understand tools for completion by both patients and nurses in critical care. Structured interviews were undertaken with 82 patients and 82 nurses using a convenience sample from four multispecialty critical care units in one large teaching trust. Patients were included in the study if they met a list of pre-defined criteria to obtain responses from lucid orientated patients. No tool produced a close association between the nurses' assessment of the patients sleep and the patients' assessment of their sleep. Patients found two of the three tools easy to use when rating their sleep. Discussion. Objective invasive measurements of sleep as well as complex subjective tools appear inappropriate to be used as a part of daily critical care practice. The application of simple rating scores has a high degree of error when nurses assess patients' sleep, even though high levels of patient observation and assessment are practiced in critical care. More research is needed to examine the assessment of sleep in critical care, particularly linking rating scales to alternative

Experience of sleep in individuals with spinal cord injury

PubMed Central

Fogelberg, Donald J.; Leland, Natalie E.; Blanchard, Jeanine; Rich, Timothy J.; Clark, Florence A.

2017-01-01

Background Poor sleep contributes to adverse health outcomes making it important to understand sleep in medically vulnerable populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively impact sleep, or to consequences of poor sleep in this population. Objectives To examine the experience of sleep among individuals with SCI. Methodology Secondary analysis using thematic coding of qualitative data from an ethnographic study of community-dwelling adults with SCI. Results Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. Conclusion This study highlights the extent of sleep disturbance experienced after SCI, the subsequent impact on occupational performance, and provides direction for clinical practice. PMID:28196449

FPGA-based sleep apnea screening device for home monitoring.

PubMed

Al-Ashmouny, K haledM; Hamed, Hisham M; Morsy, Ahmed A

2006-01-01

We present the hardware design of an FPGA-based portable device for home screening of sleep apnea syndromes. The device is simple to use, inexpensive, and uses only three signals, namely the nasal air flow and the thorax and abdomen effort signals. The device hardware stores data of overnight sleep on a Secure Digital card. At the clinic, the sleep specialist reads in the stored data and uses an algorithm for the detection and classification of sleep apnea. The device is fairly low-cost and may help spread the ability to diagnose more cases of sleep apnea. Most sleep apnea cases currently go undiagnosed because of cost and practicality limitations of overnight polysomnography at sleep labs.

[Comorbidities of heart failure: sleep apnea].

PubMed

Woehrle, H; Oldenburg, O; Stadler, S; Arzt, M

2018-05-01

Since sleep apnea often occurs in heart failure, physicians regularly need to decide whether further diagnostic procedures and/or treatment are required. Which types of sleep apnea occur in heart failure patients? When is treatment needed? Which treatments and treatment goals are appropriate? Clinical trials and guidelines as well as their implementation in clinical practice are discussed. At least 40% of patients with heart failure, both with reduced and preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively), suffer from relevant sleep apnea. In heart failure patients both obstructive and central sleep apnea are associated with increased mortality. In HFrEF as well as in HFpEF patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) achieves symptomatic and functional improvements. In patients with HFpEF, positive airway pressure treatment of central sleep apnea may be beneficial. In patients with HFrEF and left ventricular ejection fraction ≤45%, adaptive servoventilation is contraindicated. Sleep apnea is highly prevalent in heart failure patients and its treatment in specific patient groups can improve symptoms and functional outcomes. Thus, testing for sleep apnea is recommended.

When a gold standard isn't so golden: Lack of prediction of subjective sleep quality from sleep polysomnography.

PubMed

Kaplan, Katherine A; Hirshman, Jason; Hernandez, Beatriz; Stefanick, Marcia L; Hoffman, Andrew R; Redline, Susan; Ancoli-Israel, Sonia; Stone, Katie; Friedman, Leah; Zeitzer, Jamie M

2017-02-01

Reports of subjective sleep quality are frequently collected in research and clinical practice. It is unclear, however, how well polysomnographic measures of sleep correlate with subjective reports of prior-night sleep quality in elderly men and women. Furthermore, the relative importance of various polysomnographic, demographic and clinical characteristics in predicting subjective sleep quality is not known. We sought to determine the correlates of subjective sleep quality in older adults using more recently developed machine learning algorithms that are suitable for selecting and ranking important variables. Community-dwelling older men (n=1024) and women (n=459), a subset of those participating in the Osteoporotic Fractures in Men study and the Study of Osteoporotic Fractures study, respectively, completed a single night of at-home polysomnographic recording of sleep followed by a set of morning questions concerning the prior night's sleep quality. Questionnaires concerning demographics and psychological characteristics were also collected prior to the overnight recording and entered into multivariable models. Two machine learning algorithms, lasso penalized regression and random forests, determined variable selection and the ordering of variable importance separately for men and women. Thirty-eight sleep, demographic and clinical correlates of sleep quality were considered. Together, these multivariable models explained only 11-17% of the variance in predicting subjective sleep quality. Objective sleep efficiency emerged as the strongest correlate of subjective sleep quality across all models, and across both sexes. Greater total sleep time and sleep stage transitions were also significant objective correlates of subjective sleep quality. The amount of slow wave sleep obtained was not determined to be important. Overall, the commonly obtained measures of polysomnographically-defined sleep contributed little to subjective ratings of prior-night sleep quality

When a gold standard isn't so golden: Lack of prediction of subjective sleep quality from sleep polysomnography

PubMed Central

Kaplan, Katherine A.; Hirshman, Jason; Hernandez, Beatriz; Stefanick, Marcia L.; Hoffman, Andrew R.; Redline, Susan; Ancoli-Israel, Sonia; Stone, Katie; Friedman, Leah; Zeitzer, Jamie M.

2016-01-01

Background Reports of subjective sleep quality are frequently collected in research and clinical practice. It is unclear, however, how well polysomnographic measures of sleep correlate with subjective reports of prior-night sleep quality in elderly men and women. Furthermore, the relative importance of various polysomnographic, demographic and clinical characteristics in predicting subjective sleep quality is not known. We sought to determine the correlates of subjective sleep quality in in older adults using more recently developed machine learning algorithms that are suitable for selecting and ranking important variables. Methods Community-dwelling older men (n=1024) and women (n=459), a subset of those participating in the Osteoporotic Fractures in Men study and the Study of Osteoporotic Fractures study, respectively, completed a single night of at-home polysomnographic recording of sleep followed by a set of morning questions concerning the prior night's sleep quality. Questionnaires concerning demographics and psychological characteristics were also collected prior to the overnight recording and entered into multivariable models. Two machine learning algorithms, lasso penalized regression and random forests, determined variable selection and the ordering of variable importance separately for men and women. Results Thirty-eight sleep, demographic and clinical correlates of sleep quality were considered. Together, these multivariable models explained only 11-17% of the variance in predicting subjective sleep quality. Objective sleep efficiency emerged as the strongest correlate of subjective sleep quality across all models, and across both sexes. Greater total sleep time and sleep stage transitions were also significant objective correlates of subjective sleep quality. The amount of slow wave sleep obtained was not determined to be important. Conclusions Overall, the commonly obtained measures of polysomnographically-defined sleep contributed little to

Sleep-related automatism and the law.

PubMed

Ebrahim, Irshaad Osman; Fenwick, Peter

2008-04-01

Crimes carried out during or arising from sleep highlight many difficulties with our current law and forensic sleep medicine clinical practice. There is a need for clarity in the law and agreement between experts on a standardised form of assessment and diagnosis in these challenging cases. We suggest that the time has come for a standardised, internationally recognised diagnostic protocol to be set as a minimum standard in all cases of suspected sleep-related forensic cases. The protocol of a full medical history, sleep history, psychiatric history, neuropsychiatric and psychometric examination and electroencephalography (EEG), should be routine. It should now be mandatory to carry out routine polysomnography (PSG) to establish the presence of precipitating and modulating factors. Sleepwalking is classified as insane automatism in England and Wales and sudden arousal from sleep in a non-sleepwalker as sane automatism. The recent case in England of R v. Lowe (2005) highlights these anomalies. Moreover, the word insanity stigmatises sleepwalkers and should be dropped. The simplest solution to these problems would be for the law to be changed so that there is only one category of defence for all sleep-related offences--not guilty by reason of sleep disorder. This was rejected by the House of Lords for cases of automatism due to epilepsy, and is likely to be rejected for sleepwalkers. Removing the categories of automatism (sane or insane) would be the best solution. Risk assessment is already standard practice in the UK and follow up, subsequent to disposal, by approved specialists should become part of the sentencing process. This will provide support for the defendant and protection of the public.

Health Promotion in Obstructive Sleep Apnea Syndrome

PubMed Central

Corrêa, Camila de Castro; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

2015-01-01

Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: “Health Promotion,” “Sleep Disorders,” “Primary Prevention,” “Health Education,” and “Obstructive Sleep Apnea Syndromes.” Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices. PMID:25992174

Sleep: Important Considerations for the Prevention of Cardiovascular Disease

PubMed Central

Grandner, Michael A.; Alfonso-Miller, Pamela; Fernandez-Mendoza, Julio; Shetty, Safal; Shenoy, Sundeep; Combs, Daniel

2016-01-01

Purpose of Review Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. Current Findings Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities. Summary Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice. PMID:27467177

The Improvement of Sleep by Oral Intake of GABA and Apocynum venetum Leaf Extract.

PubMed

Yamatsu, Atsushi; Yamashita, Yusuke; Maru, Isafumi; Yang, Jinwei; Tatsuzaki, Jin; Kim, Mujo

2015-01-01

The effects of two food materials, γ-aminobutyric acid (GABA) produced by natural fermentation and Apocynum venetum leaf extract (AVLE), on the improvement of sleep were investigated in humans. The electroencephalogram (EEG) test revealed that oral administration of GABA (100 mg) and AVLE (50 mg) had beneficial effects on sleep. GABA shortened sleep latency by 5.3 min and AVLE increased non-rapid eye movement (REM) sleep time by 7.6%. Simultaneous intake of GABA and AVLE shortened sleep latency by 4.3 min and increased non-REM sleep time by 5.1%. The result of questionnaires showed that GABA and AVLE enabled subjects to realize the effects on sleep. These results mean that GABA can help people to fall asleep quickly, AVLE induces deep sleep, and they function complementarily with simultaneous intake. Since both GABA and AVLE are materials of foods and have been ingested for a long time, they can be regarded as safe and appropriate for daily intake in order to improve the quality of sleep.

University Students' Involvement in Body Piercing and Adherence to Safe Piercing Practices: Do Males and Females Differ?

ERIC Educational Resources Information Center

King, Keith A.; Vidourek, Rebecca A.

2007-01-01

Background: Health concerns of body piercing include infection, scarring, allergic reactions, pain, and disease. Current gaps in the research include students' perceived piercing risks and safe piercing practices. Purpose: The purpose of this study was to examine university students' involvement in body piercing, risk consideration and adherence…

A Cognitive Vulnerability Model of Sleep and Mood in Adolescents under Naturalistically Restricted and Extended Sleep Opportunities

PubMed Central

Bei, Bei; Wiley, Joshua F.; Allen, Nicholas B.; Trinder, John

2015-01-01

Study Objectives: School terms and vacations represent naturally occurring periods of restricted and extended sleep opportunities. A cognitive model of the relationships among objective sleep, subjective sleep, and negative mood was tested across these periods, with sleep-specific (i.e., dysfunctional beliefs and attitudes about sleep) and global (i.e., dysfunctional attitudes) cognitive vulnerabilities as moderators. Design: Longitudinal study over the last week of a school term (Time-E), the following 2-w vacation (Time-V), and the first week of the next term (Time-S). Setting: General community. Participants: 146 adolescents, 47.3% male, mean age = 16.2 years (standard deviation ± 1 year). Interventions: N/A. Measurements and Results: Objective sleep was measured continuously by actigraphy. Sociodemographics and cognitive vulnerabilities were assessed at Time-E; subjective sleep, negative mood (anxiety and depressive symptoms), and academic stress were measured at each time point. Controlling for academic stress and sex, subjective sleep quality mediated the relationship between objective sleep and negative mood at all time points. During extended (Time-V), but not restricted (Time-E and Time-S) sleep opportunity, this mediation was moderated by global cognitive vulnerability, with the indirect effects stronger with higher vulnerability. Further, at Time-E and Time-V, but not Time-S, greater sleep-specific and global cognitive vulnerabilities were associated with poorer subjective sleep quality and mood, respectively. Conclusions: Results highlighted the importance of subjective sleep perception in the development of sleep related mood problems, and supported the role of cognitive vulnerabilities as potential mechanisms in the relationships between objective sleep, subjective sleep, and negative mood. Adolescents with higher cognitive vulnerability are more susceptible to perceived poor sleep and sleep related mood problems. These findings have practical

Companionable sleep: Social regulation of sleep and co-sleeping in Egyptian families

PubMed Central

Worthman, Carol M.; Brown, Ryan A.

2013-01-01

This exploratory study examines family sleep patterns and quality in a setting of normative napping and co-sleeping. Participants comprised 78 members of 16 families from two locales in Egypt, Cairo and village. Each family member provided a history of sleeping arrangements, one week of continuous activity records, and details of each sleep event. Sleep records documented late-onset and dispersed sleep patterns with extensive co-sleeping. Of recorded sleep events, 69% involved co-sleeping, 24% included more than one co-sleeper, and only 21% were solitary. Mid-late afternoon napping occurred on 31% of days and night sleep onsets averaged after midnight. Age and gender structured sleep arrangements and together with locale, extensively explained sleep behavior (onset, duration, total) and quality. Co-sleepers had fewer night arousals, shorter and less variable night sleep duration, and less total sleep. Increased solitary sleep in adolescents and young adults was associated with increased sleep dysregulation, including exaggerated phase shifts in males and more nighttime arousals in females. Where normative, co-sleeping may provide psychosensory stimuli that moderate arousal and stabilize sleep. Such moderating features may address important self-regulatory developmental needs during adolescence. PMID:17371117

Effects of a sleep education program with self-help treatment on sleeping patterns and daytime sleepiness in Japanese adolescents: A cluster randomized trial.

PubMed

Tamura, Norihisa; Tanaka, Hideki

2016-01-01

Subjective insufficient sleep and delayed sleep-wake patterns have been reported as the primary causes for daytime sleepiness, a reasonably significant and prevalent problem for adolescents worldwide. Systematic reviews have indicated that the success of sleep education programs has thus far been inconsistent, due to the lack of a tailored approach that allows for evaluation of individual differences in behavior patterns. One way to resolve this problem is to assess the individual sleep behaviors of adolescents by using a checklist containing the recommended behaviors for promoting sleep health. Such self-help education programs have already been implemented for elementary school children, school nurses and the elderly. The present study aimed to verify the effects of a sleep education program with supplementary self-help treatment, based on a checklist of sleep-promoting behaviors, in addition to evaluation of changes in sleeping patterns, sleep-promoting behaviors and daytime sleepiness in adolescents. A cluster randomized controlled trial involving 5 Japanese junior high schools was conducted, and 243 students (sleep education: n = 122; waiting list: n = 121; 50.6% female; 7th grade) were included in the final analysis. The sleep education group was provided with information on proper sleep health and sleep-promoting behaviors. The students in this group were asked to practice one sleep-promoting behavior as a goal for 2 weeks and to monitor their practice using sleep diaries. Both pre- and post-treatment questionnaires were administered to students in order to assess knowledge of sleep-promoting behaviors, sleeping patterns and daytime functioning. Students in the sleep education group showed significant improvement in their knowledge of sleep health (F1,121 = 648.05, p < 0.001) and in their sleep-promoting behaviors (F1,121 = 55.66, p < 0.001). Bedtime on both school nights (F1,121 = 50.86, p < 0.001) and weekends (F1,121 = 15.03, p < 0.001), sleep

Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial.

PubMed

van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

2016-04-02

Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared

Screening midlife women for sleep problems: why, how, and who should get a referral?

PubMed

Lee, Kathryn A; Anderson, Debra J

2015-07-01

Advancements in sleep medicine have been escalating ever since research began appearing in the 1950s. As with most early clinical trials, women were excluded from participation. Even if researchers included women or addressed sex differences by age, reproductive stage was seldom considered. Recently, there has been an exponential increase in research on sleep in midlife and older women. This Practice Pearl briefly reviews the importance of adequate sleep, clinical assessment for sleep disorders, and guidelines for practice.

Theoretical and practical considerations in the application of whole body plethysmography to sleep research.

PubMed

Stephenson, Richard; Gucciardi, Enza J

2002-07-01

The sleep-wake state has a profound influence on many, perhaps most, aspects of normal physiology and is strongly implicated in the mediation (or remediation) of impaired health and performance. Many sleep disorders stem from abnormal respiratory anatomy or sleep-induced changes in respiratory control, underscoring the need for research into the effects of the sleep-wake state on respiratory control processes. Whole body plethysmography is being increasingly used to study respiration in freely behaving animals, and is especially well suited to studies of sleeping animals and human subjects. The method is simple in principle, but care is required in its application to ensure reliable results, and there are circumstances in which it is an inappropriate technique. This review describes the main advantages, pitfalls, and limitations inherent in the use of whole body plethysmography for non-invasive measurement of lung ventilation and metabolic rate in sleeping animals. Sources of potential error, and ways of avoiding such errors, are discussed, with reference to studies involving animal models of sleep-related breathing disorders.

Genetic Dissociation of Daily Sleep and Sleep Following Thermogenetic Sleep Deprivation in Drosophila

PubMed Central

Dubowy, Christine; Moravcevic, Katarina; Yue, Zhifeng; Wan, Joy Y.; Van Dongen, Hans P.A.; Sehgal, Amita

2016-01-01

Study Objectives: Sleep rebound—the increase in sleep that follows sleep deprivation—is a hallmark of homeostatic sleep regulation that is conserved across the animal kingdom. However, both the mechanisms that underlie sleep rebound and its relationship to habitual daily sleep remain unclear. To address this, we developed an efficient thermogenetic method of inducing sleep deprivation in Drosophila that produces a substantial rebound, and applied the newly developed method to assess sleep rebound in a screen of 1,741 mutated lines. We used data generated by this screen to identify lines with reduced sleep rebound following thermogenetic sleep deprivation, and to probe the relationship between habitual sleep amount and sleep following thermogenetic sleep deprivation in Drosophila. Methods: To develop a thermogenetic method of sleep deprivation suitable for screening, we thermogenetically stimulated different populations of wake-promoting neurons labeled by Gal4 drivers. Sleep rebound following thermogenetically-induced wakefulness varies across the different sets of wake-promoting neurons that were stimulated, from very little to quite substantial. Thermogenetic activation of neurons marked by the c584-Gal4 driver produces both strong sleep loss and a substantial rebound that is more consistent within genotypes than rebound following mechanical or caffeine-induced sleep deprivation. We therefore used this driver to induce sleep deprivation in a screen of 1,741 mutagenized lines generated by the Drosophila Gene Disruption Project. Flies were subjected to 9 h of sleep deprivation during the dark period and released from sleep deprivation 3 h before lights-on. Recovery was measured over the 15 h following sleep deprivation. Following identification of lines with reduced sleep rebound, we characterized baseline sleep and sleep depth before and after sleep deprivation for these hits. Results: We identified two lines that consistently exhibit a blunted increase in the

Genetic Dissociation of Daily Sleep and Sleep Following Thermogenetic Sleep Deprivation in Drosophila.

PubMed

Dubowy, Christine; Moravcevic, Katarina; Yue, Zhifeng; Wan, Joy Y; Van Dongen, Hans P A; Sehgal, Amita

2016-05-01

Sleep rebound-the increase in sleep that follows sleep deprivation-is a hallmark of homeostatic sleep regulation that is conserved across the animal kingdom. However, both the mechanisms that underlie sleep rebound and its relationship to habitual daily sleep remain unclear. To address this, we developed an efficient thermogenetic method of inducing sleep deprivation in Drosophila that produces a substantial rebound, and applied the newly developed method to assess sleep rebound in a screen of 1,741 mutated lines. We used data generated by this screen to identify lines with reduced sleep rebound following thermogenetic sleep deprivation, and to probe the relationship between habitual sleep amount and sleep following thermogenetic sleep deprivation in Drosophila. To develop a thermogenetic method of sleep deprivation suitable for screening, we thermogenetically stimulated different populations of wake-promoting neurons labeled by Gal4 drivers. Sleep rebound following thermogenetically-induced wakefulness varies across the different sets of wake-promoting neurons that were stimulated, from very little to quite substantial. Thermogenetic activation of neurons marked by the c584-Gal4 driver produces both strong sleep loss and a substantial rebound that is more consistent within genotypes than rebound following mechanical or caffeine-induced sleep deprivation. We therefore used this driver to induce sleep deprivation in a screen of 1,741 mutagenized lines generated by the Drosophila Gene Disruption Project. Flies were subjected to 9 h of sleep deprivation during the dark period and released from sleep deprivation 3 h before lights-on. Recovery was measured over the 15 h following sleep deprivation. Following identification of lines with reduced sleep rebound, we characterized baseline sleep and sleep depth before and after sleep deprivation for these hits. We identified two lines that consistently exhibit a blunted increase in the duration and depth of sleep after

41 CFR 50-204.72 - Safe practices for welding and cutting on containers which have held combustibles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... welding and cutting on containers which have held combustibles. 50-204.72 Section 50-204.72 Public..., and Mists § 50-204.72 Safe practices for welding and cutting on containers which have held combustibles. Welding or cutting, or both, on containers which have held flammable or combustible solids...

41 CFR 50-204.72 - Safe practices for welding and cutting on containers which have held combustibles.

Code of Federal Regulations, 2013 CFR

2013-07-01

... welding and cutting on containers which have held combustibles. 50-204.72 Section 50-204.72 Public..., and Mists § 50-204.72 Safe practices for welding and cutting on containers which have held combustibles. Welding or cutting, or both, on containers which have held flammable or combustible solids...

41 CFR 50-204.72 - Safe practices for welding and cutting on containers which have held combustibles.

Code of Federal Regulations, 2012 CFR

2012-07-01

... welding and cutting on containers which have held combustibles. 50-204.72 Section 50-204.72 Public..., and Mists § 50-204.72 Safe practices for welding and cutting on containers which have held combustibles. Welding or cutting, or both, on containers which have held flammable or combustible solids...

41 CFR 50-204.72 - Safe practices for welding and cutting on containers which have held combustibles.

Code of Federal Regulations, 2014 CFR

2014-07-01

... welding and cutting on containers which have held combustibles. 50-204.72 Section 50-204.72 Public..., and Mists § 50-204.72 Safe practices for welding and cutting on containers which have held combustibles. Welding or cutting, or both, on containers which have held flammable or combustible solids...

41 CFR 50-204.72 - Safe practices for welding and cutting on containers which have held combustibles.

Code of Federal Regulations, 2011 CFR

2011-07-01

... welding and cutting on containers which have held combustibles. 50-204.72 Section 50-204.72 Public..., and Mists § 50-204.72 Safe practices for welding and cutting on containers which have held combustibles. Welding or cutting, or both, on containers which have held flammable or combustible solids...

Sleep in lonely heroin-dependent patients receiving methadone maintenance treatment: longer sleep latency, shorter sleep duration, lower sleep efficiency, and poorer sleep quality.

PubMed

Li, Hong-Jie; Zhong, Bao-Liang; Xu, Yan-Min; Zhu, Jun-Hong; Lu, Jin

2017-10-24

Given the socially isolated status of Chinese heroin-dependent patients (HDPs) and the significant association between loneliness and sleep problem in the general population, the impact of loneliness on sleep of HDPs is potentially substantial. The study aimed to test whether loneliness is associated with poor sleep in terms of quantity and quality in a consecutive sample of Chinese HDPs receiving methadone maintenance treatment (MMT). The study participants were 603 HDPs of three MMT clinics in Wuhan, China. Data on socio-demographic and clinical characteristics were collected by a standardized self-administered questionnaire. Sleep outcomes included sleep latency, sleep duration, sleep efficiency, and sleep quality. We measured depressive symptoms, loneliness, and sleep quality by using Zung's Self-rating Depression Scale, the single-item self-report of loneliness, and the Pittsburgh Sleep Quality Index, respectively. Multiple linear regression was used to examine whether loneliness is independently associated with sleep measures. After controlling for the confounding effects of potential socio-demographic and clinical variables, loneliness was significantly associated with longer sleep latency, shorter sleep duration, lower sleep efficiency, and poorer sleep quality. Loneliness may exacerbate sleep disturbance in Chinese HDPs of MMT clinics. Psychosocial interventions aimed at reducing loneliness in MMT clinics would improve the sleep of HDPs.

Melatonin for sleep disturbance in children with neurodevelopmental disorders: prospective observational naturalistic study.

PubMed

Ayyash, Hani F; Preece, Phillip; Morton, Richard; Cortese, Samuele

2015-06-01

Although melatonin is increasingly used for sleep disturbances in children with neurodevelopmental disorders, evidence on effective dose and impact on specific types of sleep disturbance is limited. We assessed 45 children (35 males, mean age: 6.3 ± 1.7 years) with neurodevelopmental disorders (n = 29: intellectual disability; n = 9: autism spectrum disorder; n = 7: attention-deficit/hyperactivity disorder) and sleep disturbances, treated with melatonin (mean duration: 326 days) with doses increased according to response. Thirty-eight percent of children responded to low (2.5-3 mg), 31% to medium (5-6 mg) and 9% to high doses (9-10 mg) of melatonin, with a significant increase in total hours of sleep/night, decreased sleep onset delay and decreased number of awakenings/night (all: p = 0.001), as measured with sleep diaries. No serious adverse events were reported. Melatonin is generally effective and safe in children with neurodevelopmental conditions. Increasing above 6 mg/night adds further benefit only in a small percentage of children.

Sleep-wake time perception varies by direct or indirect query.

PubMed

Alameddine, Y; Ellenbogen, J M; Bianchi, M T

2015-01-15

The diagnosis of insomnia rests on self-report of difficulty initiating or maintaining sleep. However, subjective reports may be unreliable, and possibly may vary by the method of inquiry. We investigated this possibility by comparing within-individual response to direct versus indirect time queries after overnight polysomnography. We obtained self-reported sleep-wake times via morning questionnaires in 879 consecutive adult diagnostic polysomnograms. Responses were compared within subjects (direct versus indirect query) and across groups defined by apnea-hypopnea index and by self-reported insomnia symptoms in pre-sleep questionnaires. Direct queries required a time duration response, while indirect queries required clock times from which we calculated time durations. Direct and indirect queries of sleep latency were the same in only 41% of cases, and total sleep time queries matched in only 5.4%. For both latency and total sleep, the most common discrepancy involved the indirect value being larger than the direct response. The discrepancy between direct and indirect queries was not related to objective sleep metrics. The degree of discrepancy was not related to the presence of insomnia symptoms, although patients reporting insomnia symptoms showed underestimation of total sleep duration by direct response. Self-reported sleep latency and total sleep time are often internally inconsistent when comparing direct and indirect survey queries of each measure. These discrepancies represent substantive challenges to effective clinical practice, particularly when diagnosis and management depends on self-reported sleep patterns, as with insomnia. Although self-reported sleep-wake times remains fundamental to clinical practice, objective measures provide clinically relevant adjunctive information. © 2015 American Academy of Sleep Medicine.

Sleep and Culture in Children with Medical Conditions

PubMed Central

Koinis-Mitchell, Daphne

2010-01-01

Objectives To provide an integrative review of the existing literature on the interrelationships among sleep, culture, and medical conditions in children. Methods A comprehensive literature search was conducted using PubMed, Medline, and PsychINFO computerized databases and bibliographies of relevant articles. Results Children with chronic illnesses experience more sleep problems than healthy children. Cultural beliefs and practices are likely to impact the sleep of children with chronic illnesses. Few studies have examined cultural factors affecting the relationship between sleep and illness, but existing evidence suggests the relationship between sleep and illness is exacerbated for diverse groups. Conclusions Sleep is of critical importance to children with chronic illnesses. Cultural factors can predispose children both to sleep problems and to certain medical conditions. Additional research is needed to address the limitations of the existing literature, and to develop culturally sensitive interventions to treat sleep problems in children with chronic illnesses. PMID:20332222

Ventricular assist devices and sleep-disordered breathing.

PubMed

Akkanti, Bindu; Castriotta, Richard J; Sayana, Pavani; Nunez, Emmanuel; Rajapreyar, Indranee; Kumar, Sachin; Nathan, Sriram; Majid, Ruckshanda

2017-10-01

Congestive heart failure is one of the leading causes of morbidity and mortality in the United States, and left ventricular assist devices have revolutionized treatment of end-stage heart failure. Given that sleep apnea results in significant morbidity in these patients with advanced heart failure, practicing sleep physicians need to have an understanding of left ventricular assist devices. In this review, we summarize what is known about ventricular assist devices as they relate to sleep medicine. Copyright © 2016 Elsevier Ltd. All rights reserved.

Sleep-stage sequencing of sleep-onset REM periods in MSLT predicts treatment response in patients with narcolepsy.

PubMed

Drakatos, Panagis; Patel, Kishankumar; Thakrar, Chiraag; Williams, Adrian J; Kent, Brian D; Leschziner, Guy D

2016-04-01

Current treatment recommendations for narcolepsy suggest that modafinil should be used as a first-line treatment ahead of conventional stimulants or sodium oxybate. In this study, performed in a tertiary sleep disorders centre, treatment responses were examined following these recommendations, and the ability of sleep-stage sequencing of sleep-onset rapid eye movement periods in the multiple sleep latency test to predict treatment response. Over a 3.5-year period, 255 patients were retrospectively identified in the authors' database as patients diagnosed with narcolepsy, type 1 (with cataplexy) or type 2 (without) using clinical and polysomnographic criteria. Eligible patients were examined in detail, sleep study data were abstracted and sleep-stage sequencing of sleep-onset rapid eye movement periods were analysed. Response to treatment was graded utilizing an internally developed scale. Seventy-five patients were included (39% males). Forty (53%) were diagnosed with type 1 narcolepsy with a mean follow-up of 2.37 ± 1.35 years. Ninety-seven percent of the patients were initially started on modafinil, and overall 59% reported complete response on the last follow-up. Twenty-nine patients (39%) had the sequence of sleep stage 1 or wake to rapid eye movement in all of their sleep-onset rapid eye movement periods, with most of these diagnosed as narcolepsy type 1 (72%). The presence of this specific sleep-stage sequence in all sleep-onset rapid eye movement periods was associated with worse treatment response (P = 0.0023). Sleep-stage sequence analysis of sleep-onset rapid eye movement periods in the multiple sleep latency test may aid the prediction of treatment response in narcoleptics and provide a useful prognostic tool in clinical practice, above and beyond their classification as narcolepsy type 1 or 2. © 2015 European Sleep Research Society.

Legal Aspects of Sleep Medicine in the 21st Century.

PubMed

Venkateshiah, Saiprakash B; Hoque, Romy; Collop, Nancy A

2018-05-08

Multiple manifestations of sleep disorders may interact with the law making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable due to the actions of sleepy employees. Hence awareness of causes of excessive sleepiness such as sleep deprivation and OSA is increasing among trucking, railroad, and other safety sensitive occupations. Interestingly, litigation related to perioperative complications due to Obstructive Sleep Apnea (OSA) is more frequent than non-operative issues such as a failure to diagnose OSA. Parasomnia associated sleep-related violence (SRV) represents a challenge to clinicians, as they may be asked to consider parasomnia as a possible contributing, mitigating, or exculpatory factor in criminal proceedings. Clinicians should also familiarize with the legal and regulatory aspects of running an independent sleep laboratory. Sleep telemedicine practice using 21 st century technology has opened novel and unique challenges to existing laws. In this review, we shall cover the most common interactions between sleep disorders and the law including the challenges of excessive sleepiness and driving; other legal issues involving patients with obstructive sleep apnea (OSA); and the liabilities associated with parasomnia disorder. We shall also cover some practical legal aspects involving independent sleep laboratories and the field of sleep telemedicine. Published by Elsevier Inc.

Management of sleep disorders in stroke.

PubMed

Im, Kyoung Bin; Strader, Scott; Dyken, Mark Eric

2010-09-01

Scientific studies have proven a very strong association between stroke and obstructive sleep apnea (OSA). The prevalence of OSA is very high in patients with acute stroke, and untreated OSA is a stroke risk factor. In the stroke patient population, symptoms of OSA may atypically appear as isolated insomnia, hypersomnia, a dysfunction of circadian rhythm, a parasomnia, or a sleep-related movement disorder. Thus, we believe that in patients with acute stroke, OSA should be addressed first, using full in-laboratory, attended polysomnography (PSG), before other specific sleep disorders are aggressively addressed with specific therapeutic interventions. When OSA is diagnosed, supportive techniques including the application of continuous positive airway pressure (CPAP) therapy, positional therapies, or both should be considered first-line treatments. If OSA is ruled out by PSG, the therapeutic emphasis for sleep-related complaints is routinely based on instituting good sleep hygiene practices and using cognitive behavioral techniques (cognitive therapies, sleep restriction, stimulus control, and progressive relaxation therapies) because patients with stroke may be prone to the adverse effects of many of the medications that are otherwise routinely prescribed for a variety of specific sleep disorders.

Safe handling practices of cytotoxic drugs: the results of a chapter survey.

PubMed

Mahon, S M; Casperson, D S; Yackzan, S; Goodner, S; Hasse, B; Hawkins, J; Parham, J; Rimkus, C; Schlomer, M; Witcher, V

1994-08-01

To describe how nurses from a local Oncology Nursing Society (ONS) Chapter Implement Occupational Safety and Health Administration (OSHA) guidelines for handling cytotoxic drugs (CDs) in their individual practices and to identify barriers to implementing these guidelines. Mailed survey. ONS chapter in a large midwestern city. 103 nurses, 83 of whom handle CDs. Mean years in oncology nursing was 7.5. Mailed survey consisting of 48 questions on seven topics, as well as demographic questions. Roles in preparation and administration of CDs, management spills, patient care, and use of protective equipment in patient and family education practices; barriers to use of protective practices. Subjects used some protective equipment when preparing and administering CDs, but the type of equipment and its frequency of use did not specifically meet OSHA Guidelines. Rates of compliance with guidelines were better for management of spills and disposal of equipment. Verbal instructions for patients and families were employed but very few provided written instructions or explanations. Barriers to using protective equipment included a lack of time, problems with availability, and concerns about patient reactions. Barriers must be overcome and better safe-handling practices incorporated into practice to ensure the safety of nurses. More education is needed for family members who come into contact with patients receiving CDs. Future research to document the extent of the problem, including stratification of responses according to the quantity and frequency with which a nurse administers CDs. Better, and perhaps more frequent, staff and family education efforts are needed.

Infant sleeping arrangements and cultural values among contemporary Japanese mothers

PubMed Central

Shimizu, Mina; Park, Heejung; Greenfield, Patricia M.

2014-01-01

We examined infant sleeping arrangements and cultural values of Japanese mothers in 2008 and 2009. Based on Greenfield's theory of social change and human development, we predicted that social change in Japan over the last decades (higher economic and education level, urbanization, complex technology, more women in the work force) would lead to a decline in mother-infant co-sleeping, compared with published findings concerning Japanese sleeping arrangements in the 1960s and 1980s. We also predicted that the practice of having babies sleep in their own beds and/or own rooms would be supported by ethnotheories stressing infant independence and other values adaptive in an urban, technologically sophisticated, relatively wealthy, and highly educated populace. Fifty-one Japanese mothers' comments posted on Internet parenting forums were analyzed. Contrary to our hypothesis, co-sleeping was as frequent among Japanese mothers in 2008-2009 as it had been in the 1960s and 1980s. However, analysis of the values of co-sleeping mothers revealed frequent discrepancies between values and practices. In contrast, the minority of mothers whose babies slept alone in a separate room all expressed consonant values. Our qualitative analysis indicates that it is not always easy for Japanese mothers to construct values for child rearing and gender roles that integrate traditional infant care practices with current sociodemographic conditions. PMID:25191281

Common meanings of good and bad sleep in a healthy population sample.

PubMed

Dickerson, Suzanne S; Klingman, Karen J; Jungquist, Carla R

2016-09-01

The study's purpose was to understand the common meanings and shared practices related to good and bad sleep from narratives of a sample of healthy participants. Interpretive phenomenology was the approach to analyze narratives of the participants' everyday experiences with sleep. Participants were interviewed and asked to describe typical good and bad nights' sleep, what contributes to their sleep experience, and the importance of sleep in their lives. Team interpretations of narratives identified common themes by consensus. Medium sized city in New York State (upper west region). A sample of 30 healthy participants were from a parent study (n=300) on testing the sleep questions from the Behavioral Risk Factor Surveillance System from the Centers for Disease Control and Prevention. Interpretations of good and bad sleep. Participants described similar experiences of good and bad sleep often directly related to their ability to schedule time to sleep, fall asleep, and maintain sleep. Worrying about life stresses and interruptions prevented participants from falling asleep and staying asleep. Yet, based on current life priorities (socializers, family work focused, and optimum health seekers), they had differing values related to seeking sleep opportunities and strategizing to overcome challenges. The participants' priorities reflected the context of their main concerns and stresses in life that influenced the importance given to promoting sleep opportunities. Public health messages tailored to life priorities could be developed to promote healthy sleep practices. Copyright © 2016 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing.

PubMed

Shusterman, Dennis; Baroody, Fuad M; Craig, Timothy; Friedlander, Samuel; Nsouli, Talal; Silverman, Bernard

Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance. To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps. Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources. Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity. Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep

75 FR 29391 - National Safe Boating Week, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

... Safe Boating Week, 2010 By the President of the United States of America A Proclamation Our Nation's... National Safe Boating Week to practicing safe techniques so boaters of all ages can enjoy this pastime... annually the 7-day period prior to Memorial Day weekend as ``National Safe Boating Week.'' NOW, THEREFORE...

Behavioral economics strategies for promoting adherence to sleep interventions.

PubMed

Stevens, Jack

2015-10-01

Cognitive-behavioral treatment for insomnia and continuous positive airway pressure therapy for obstructive sleep apnea are among the most efficacious sleep interventions. Unfortunately, adherence levels are disappointingly low for these interventions. Behavioral economics offers a promising framework for promoting adherence, often through relatively brief and straightforward strategies. The assumptions, goals, and key strategies of behavioral economics will be introduced. These strategies include providing social norms information, changing defaults, using the compromise effect, utilizing commitment devices, and establishing lottery-based systems. Then, this review will highlight specific behavioral economic approaches to promote patient adherence for three major sleep interventions: 1) behavioral treatment for pediatric insomnia, 2) cognitive-behavioral treatment for adult insomnia, and 3) continuous positive airway pressure for obstructive sleep apnea. Next, behavioral economic strategies will be discussed as ways to improve health care provider adherence to clinical practice guidelines regarding appropriate prescribing of hypnotics and ordering sleep-promoting practices for hospitalized inpatients. Finally, possible concerns that readers may have about behavioral economics strategies, including their efficacy, feasibility, and sustainability, will be addressed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sleep and alertness in North Sea helicopter operations.

PubMed

Simons, Ries; Wilschut, Ellen S; Valk, Pierre J L

2011-07-01

Dutch North Sea helicopter operations are characterized by multiple sector flights to offshore platforms under difficult environmental conditions. In the context of a Ministry of Transport program to improve safety levels of helicopter operations, we assessed effects of pre-duty sleep, pre-duty travel time, and workload factors on the alertness and vigilance of pilots. Data of 24 pilots comprising 224 duty days were analyzed. Pilots performed 10-min test sessions after wake up, pre-duty, halfway-duty, end-duty, and at bedtime during normal duty rosters. Test sessions included completion of a vigilance task, vigor and sleepiness ratings, and questions on sleep and operational characteristics. Pilots wore an actometer to objectify sleep data. Vigor scores were high and sleepiness levels were low during the entire flight duty periods (FDPs), while vigilance was impaired only 6.8% in the course of the FDPs. Pre-duty sleep before morning duties was 1.5 h shorter than sleep before duties starting after midday. Longer pre-duty travel time was correlated with shorter pre-duty sleep and lower vigilance levels during duty. During the FDPs, pilots maintained alertness and vigilance levels that may be considered safe in terms of alertness-related flight safety. This favorable outcome may be attributed to reasonable length of FDPs, favorable circadian start and end times of duties, sufficient opportunities for restorative pre-duty sleep, and relatively good weather conditions. Appropriate FDP scheduling is an important measure to optimize alertness of helicopter pilots who have to cope with adverse environmental conditions and limited landing and air traffic control facilities.

Selected sleep disorders: restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy.

PubMed

Erman, Milton K

2006-12-01

Sleep disorders, including restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy, are prevalent medical conditions, likely to be seen by practicing psychiatrists. Awareness of these conditions and their presentations, pathophysiology, and treatment allows psychiatrists to treat these conditions where appropriate, to minimize complications and health consequences associated with delayed diagnosis, and to reduce the burden of disease that these conditions may place on patients already experiencing primary psychiatric disorders.

Sleep in children with autistic spectrum disorder.

PubMed

Cortesi, Flavia; Giannotti, Flavia; Ivanenko, Anna; Johnson, Kyle

2010-08-01

Children and adolescents with autistic spectrum disorders (ASD) suffer from sleep problems, particularly insomnia, at a higher rate than typically developing children, ranging from 40% to 80%. Sleep problems in ASD might occur as a result of complex interactions between biological, psychological, social/environmental, and family factors, including child rearing practices that are not conducive to good sleep. Interestingly, children with a history of developmental regression have a more disturbed sleep pattern than children without regression. Even though regulation of sleep in children with ASD is still poorly understood, circadian abnormalities in autism might be the result of genetic abnormalities related to melatonin synthesis and melatonin's role in modulating synaptic transmission. Recently a bifurcation of the sleep/wake cycle with increased sensitivity to external noise and short sleep duration causing irregular sleep onset and wake up times has been suggested. Identifying and treating sleep disorders may result not only in improved sleep, but also impact favorably on daytime behavior and family functioning. Several studies have also demonstrated effectiveness of behavioral interventions for sleep onset and maintenance problems in these populations. When behavioral interventions are not effective or lead only to a partial response, pharmacological treatment options should be considered. Studies of melatonin use in children with ASD provide evidence for its effectiveness and safety in the long run. The clinician assessing a child with an ASD should screen carefully for sleep disorders and make referrals as indicated. Copyright 2010 Elsevier B.V. All rights reserved.

Consumer sleep tracking devices: a critical review.

PubMed

Lee, Jeon; Finkelstein, Joseph

2015-01-01

Consumer sleep tracking devices are widely advertised as effective means to monitor and manage sleep quality and to provide positive effects on overall heath. However objective evidence supporting these claims is not always readily available. The goal of this study was to perform a comprehensive review of available information on six representative sleep tracking devices: BodyMedia FIT, Fitbit Flex, Jawbone UP, Basis Band, Innovative Sleep Solutions SleepTracker, and Zeo Sleep Manager Pro. The review was conducted along the following dimensions: output metrics, theoretical frameworks, systematic evaluation, and FDA clearance. The review identified a critical lack of basic information about the devices: five out of six devices provided no supporting information on their sensor accuracy and four out of six devices provided no information on their output metrics accuracy. Only three devices were found to have related peer-reviewed articles. However in these articles wake detection accuracy was revealed to be quite low and to vary widely (BodyMedia, 49.9±3.6%; Fitbit, 19.8%; Zeo, 78.9% to 83.5%). No supporting evidence on how well tracking devices can help mitigate sleep loss and manage sleep disturbances in practical life was provided.

A Narrative Review of How Sleep Related Breathing Disorders and Cardiovascular Diseases are Linked: An update for advanced practice registered nurses

PubMed Central

Phelan, Cynthia H.; Lauver, Diane R.; Bratzke, Lisa C.

2016-01-01

Purpose/ Objectives Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses (APRNs) on the literature focusing on the relationship between SRBDs and CVD (e.g., hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. Description of the project We conducted an electronic search of the literature published between1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resources websites to address the aims of this study. Outcomes Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. Conclusions This review found a close relationship between SRBDs and CVD. APRNs are in key positions to identify and help patients manage SRBDs. In particular, APRNs can educate staff and establish standards of practice to improve outcomes for CVD patients. PMID:27753673

Diurnal Emotional States Impact the Sleep Course

PubMed Central

Delannoy, Julien; Mandai, Osamu; Honoré, Jacques; Kobayashi, Toshinori; Sequeira, Henrique

2015-01-01

practices designed to alleviate sleep disturbances. PMID:26606526

[Sleep disturbances and suicidality: relationships and clinical implications].

PubMed

Norra, C; Richter, N

2013-10-01

Besides several risk factors for suicide, there is a recent increase in clinical and epidemiological studies pointing to a potential relationship between sleep loss or sleep disturbances and suicidality. This work, based on a systematic literature research, gives an overview on the findings of relationships between suicidality (i. e., suicidal thoughts, suicide attempts, suicides) and sleep disturbances, especially insomnia, nightmares, but also hypersomnia and nocturnal panic attacks. There is evidence that sleep disturbances in suicidal insomniacs with comorbid psychiatric disorder are independently predictive for suicidality, too. Shared aspects of pathogenesis of the two entities and therapeutic options are also discussed. Recognition of sleep disturbances is essential for suicide prevention in clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

Is there a First Night Effect on Sleep Bruxism? A Sleep Laboratory Study

PubMed Central

Hasegawa, Yoko; Lavigne, Gilles; Rompré, Pierre; Kato, Takafumi; Urade, Masahiro; Huynh, Nelly

2013-01-01

Study Objectives: Sleep bruxism (SB) is reported to vary in frequency over time. The aim of this study was to assess the first night effect on SB. Methods: A retrospective polysomnographic (PSG) analysis was performed of data from a sample of SB patients (12 females, 4 males; age range: 17-39 years) recorded in a sleep laboratory over 2 consecutive nights. Sleep parameters and jaw muscle activity variables (i.e., rhythmic masticatory muscle activity [RMMA]) for SB were quantified and compared between the 2 nights. Subjects were classified into groups according to severity of RMMA frequency, such as low frequency (2-4 episodes/h and/or < 25 bursts/h) and moderate-high frequency (≥ 4 episodes/h and ≥ 25 bursts/h). Results: Overall, no first night effects were found for most sleep variables. However, total sleep time, sleep efficiency, and stage transitions showed significant time and group interactions (repeated measures ANOVAs, p ≤ 0.05). The RMMA episode index did not differ between the 2 nights, whereas the second night showed significantly higher burst index, bruxism time index, and mean burst duration (repeated measure ANOVAs, p ≤ 0.05). Five patients of 8 in the low frequency group were classified into the moderate-high frequency group on the second night, whereas only one patient in the moderate-high frequency group moved to the low frequency group. Conclusions: The results showed no overall first night effect on severity of RMMA frequency in young and healthy patients with SB. In clinical practice, one-night sleep recording may be sufficient for moderate-high frequency SB patients. However, low RMMA frequency in the first night could be confirmed by a second night based on the patient's medical and dental history. Citation: Hasegawa Y; Lavigne G; Rompré P; Kato T; Urade M; Huynh N. Is there a first night effect on sleep bruxism? A sleep laboratory study. J Clin Sleep Med 2013;9(11):1139-1145. PMID:24235894

Sleep disruption in critically ill patients--pharmacological considerations.

PubMed

Bourne, R S; Mills, G H

2004-04-01

Sleep disturbances are common in critically ill patients and contribute to morbidity. Environmental factors, patient care activities and acute illness are all potential causes of disrupted sleep. Additionally, it is important to consider drug therapy as a contributing factor to this adverse experience, which patients perceive as particularly stressful. Sedative and analgesic combinations used to facilitate mechanical ventilation are among the most sleep disruptive drugs. Cardiovascular, gastric protection, anti-asthma, anti-infective, antidepressant and anticonvulsant drugs have also been reported to cause a variety of sleep disorders. Withdrawal reactions to prescribed and occasionally recreational drugs should also be considered as possible triggers for sleep disruption. Tricyclic antidepressants and benzodiazepines are commonly prescribed in the treatment of sleep disorders, but have problems with decreasing slow wave and rapid eye movement sleep phases. Newer non-benzodiazepine hypnotics offer little practical advantage. Melatonin and atypical antipsychotics require further investigation before their routine use can be recommended.

Neuroimmunologic aspects of sleep and sleep loss

NASA Technical Reports Server (NTRS)

Rogers, N. L.; Szuba, M. P.; Staab, J. P.; Evans, D. L.; Dinges, D. F.

2001-01-01

The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans. Copyright 2001 by W.B. Saunders Company.

Sleep and intercontinental flights.

PubMed

Nicholson, Anthony N

2006-12-01

At present there are no 'high-tech' solutions to the problems that may beset intercontinental travellers. Indications for the use of drugs are limited, and their use must accord with Good Clinical Practice. Essentially, travellers must look after their sleep, as far as possible, during and after the flight. The most useful time for sleep during the flight must be anticipated, caution exercised in the use of hypnotics in-flight as reduced mobility is a potential risk factor for venous thrombosis, and a strategy adopted, whether flying east or west, to adapt as quickly as possible to the working hours of the new locality. After an eastward flight a hypnotic may be useful, but this strategy is seldom necessary after a westward flight unless the journey has involved crossing more than 5 or 6 time zones. The claim that melatonin accelerates the shift of the sleep-wakefulness cycle to a new time zone is controversial, and its recommended use may prejudice alertness during working hours. Exposure to artificial light and avoidance of ambient light at certain times of the day could prove to be of help-possibly in conjunction with drugs. However, effective and practical alterations in the light environment must be devised before such strategies can be considered with confidence.

How mindfulness changed my sleep: focus groups with chronic insomnia patients.

PubMed

Hubbling, Amber; Reilly-Spong, Maryanne; Kreitzer, Mary Jo; Gross, Cynthia R

2014-02-10

Chronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness ('mindfulness training') may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits. Adults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis. Four themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain

What Is the Effect of Strength Training on Pain and Sleep in Patients With Fibromyalgia?

PubMed

Andrade, Alexandro; Vilarino, Guilherme Torres; Bevilacqua, Guilherme Guimarães

2017-12-01

The study aimed to investigate the effect of an 8-wk structured strength training program on pain and sleep quality in patients with fibromyalgia. Fifty-two patients with fibromyalgia were evaluated; 31 submitted to strength training and 21 comprised the control group. The instruments used were the Fibromyalgia Impact Questionnaire and The Pittsburgh Sleep Quality Index. The questionnaires were applied before the first training session, at 12 sessions, and after 24 sessions. Descriptive statistics (mean, SD, and frequency) and inferential tests were used. After 8 wks of intervention, significant differences were found between groups in subjective quality of sleep (P = 0.03), sleep disturbance (P = 0.02), daytime dysfunction (P = 0.04), and total sleep score (P < 0.01). The correlation analysis using Spearman's test indicated a positive relationship between the variables of pain intensity and sleep quality (P < 0.01); when pain intensity increased in patients with fibromyalgia, sleep quality worsened. Strength training is safe and effective in treating people with fibromyalgia, and a significant decrease in sleep disturbances occurs after 8 wks of intervention.

Psycho-social stress, insomnia and temazepam: a sleep laboratory evaluation in a "general practice" sample.

PubMed

Beary, M D; Lacey, J H; Crutchfield, M B; Bhat, A V

1984-01-01

Taking a population of women most of whom were about to seek medication from their general practitioner for stress-induced insomnia, this sleep laboratory study examined--both electro -physiologically and psychologically--the immediate impact of temazepam, at normal prescribed dosage, on sleep. The study was double-blind, controlled with random allocation. Temazepam 20 mg, prepared as a liquid in a soft gelatin capsule, reduced sleep latency and prolonged total sleep time. A reduction in stage shifts to Stages I and II and a reduction in time spent in Stages 0 + I suggest more restful sleep. The sleep "architecture" (including REM/NREM cycling, total SWS and REM time) was relatively undisturbed. Temazepam would seem to be effective as a first-line hypnotic for short-term use in stressed patients.

Sleep Duration and Waist Circumference in Adults: A Meta-Analysis.

PubMed

Sperry, Susan D; Scully, Iiona D; Gramzow, Richard H; Jorgensen, Randall S

2015-08-01

Previous research has demonstrated a relation between insufficient sleep and overall obesity. Waist circumference (WC), a measure of central adiposity, has been demonstrated to improve prediction of health risk. However, recent research on the relation of insufficient sleep duration to WC in adults has yielded inconsistent findings. To assess the magnitude and the consistency of the relation of insufficient sleep and WC. A systematic search of Internet and research databases using Google Scholar, Medline, PubMed, and PsycINFO through July 2013 was conducted. All articles in English with adult human subjects that included measurements of WC and sleep duration were reviewed. A random effects meta-analysis and regression analyses were performed. Heterogeneity and publication bias were checked. Results are expressed as Pearson correlations (r; 95% confidence interval). Of 1,376 articles, 30 met inclusion criteria and 21 studies (22 samples for a total of 56,259 participants) provided sufficient data for meta-analysis. Results showed a significant negative relation between sleep duration and WC (r = -0.10, P < 0.0001) with significant heterogeneity related to sleep comparison method. Potential moderators of the relation between sleep duration and WC were not significant. Funnel plots showed no indication of publication bias. In addition, a fail-safe N calculation indicated that 418 studies with null effects would be necessary to bring the overall mean effect size to a trivial value of r = -0.005. Internationally, cross-sectional studies demonstrate a significant negative relation between sleep duration and waist circumference, indicating shorter sleep durations covary with central adiposity. Future research should include prospective studies. © 2015 Associated Professional Sleep Societies, LLC.

Catalogue of knowledge and skills for sleep medicine.

PubMed

Penzel, Thomas; Pevernagie, Dirk; Dogas, Zoran; Grote, Ludger; de Lacy, Simone; Rodenbeck, Andrea; Bassetti, Claudio; Berg, Søren; Cirignotta, Fabio; d'Ortho, Marie-Pia; Garcia-Borreguero, Diego; Levy, Patrick; Nobili, Lino; Paiva, Teresa; Peigneux, Philippe; Pollmächer, Thomas; Riemann, Dieter; Skene, Debra J; Zucconi, Marco; Espie, Colin

2014-04-01

Sleep medicine is evolving globally into a medical subspeciality in its own right, and in parallel, behavioural sleep medicine and sleep technology are expanding rapidly. Educational programmes are being implemented at different levels in many European countries. However, these programmes would benefit from a common, interdisciplinary curriculum. This 'catalogue of knowledge and skills' for sleep medicine is proposed, therefore, as a template for developing more standardized curricula across Europe. The Board and The Sleep Medicine Committee of the European Sleep Research Society (ESRS) have compiled the catalogue based on textbooks, standard of practice publications, systematic reviews and professional experience, validated subsequently by an online survey completed by 110 delegates specialized in sleep medicine from different European countries. The catalogue comprises 10 chapters covering physiology, pathology, diagnostic and treatment procedures to societal and organizational aspects of sleep medicine. Required levels of knowledge and skills are defined, as is a proposed workload of 60 points according to the European Credit Transfer System (ECTS). The catalogue is intended to be a basis for sleep medicine education, for sleep medicine courses and for sleep medicine examinations, serving not only physicians with a medical speciality degree, but also PhD and MSc health professionals such as clinical psychologists and scientists, technologists and nurses, all of whom may be involved professionally in sleep medicine. In the future, the catalogue will be revised in accordance with advances in the field of sleep medicine. © 2013 European Sleep Research Society.

[Habits and problems of sleep in adolescent students].

PubMed

Lazaratou, E; Dikeos, D; Anagnostopoulos, D; Soldatos, C

2008-07-01

The evaluation of sleep habits and sleep related problems in high school adolescent students in the Athens area and the assessment of these problems' relation to demographic and other variables was investigated by the Athens Insomnia Scale - 5 item version (AIS-5), which was administered to 713 adolescent Senior High School students in the Greater Athens Area. Data such as age, sex, school records, and time spent per week in school-related and extracurricular activities were collected. The sample's mean sleep duration was 7,5 hours, mean bedtime 12:20 am and wake-up time 7:15 am. Total sleep time was not affected by gender, but was influenced by time spent in various activities. Sleep complaints were related to delayed sleep, onset latency and insufficient total duration of sleep. Girls complained more than boys, while correlations showed that students with lower academic per formance and those in second grade were more likely to have higher AIS-5 scores. The results show that sleep time of high school students is dependent on practical matters such as school schedule and other activities, while sleep complaints are related to female gender, bad school performance as well as to the second grade. The difference between actual sleep time and sleep complaints should be considered when studying the sleep of adolescents.

Integrative literature review: sleep patterns in infants attending nurseries.

PubMed

Cerqueira, Ana Carolina Dantas Rocha; Cardoso, Maria Vera Lúcia Moreira Leitão; Viana, Tamires Rebeca Forte; Lopes, Márcia Maria Coelho Oliveira

2018-01-01

To identify evidence available in the literature about sleep patterns of infants attending nurseries. An integrative review of studies published in Portuguese, English or Spanish available in full text on LILACS, CINAHL, and PubMed databases. The following descriptors sono, lactente and creches or berçários (in Portuguese) and sleep, infant and childcare or nurseries were used for LILACS, CINAHL and Pubmed, respectively. Nine studies were selected and analyzed. The main component explored in the studies about sleep pattern is the sleep position of the infants, due to its association with sudden infant death syndrome. The results pointed to the need to promote and develop written guidelines regarding behavioral practices to reduce the risk of this phenomenon. Evidence has identified sleep issues, mainly regarding the sleep position of the infant and the environment where the infant sleeps, showing that it is critical to set routines and interventions to improve the quality of sleep care of infants attending nurseries.

Sleep Applications to Assess Sleep Quality.

PubMed

Fietze, Ingo

2016-12-01

This article highlights the potential uses that smartphone applications may have for helping those with sleep problems. Applications in smartphones offer the promised possibility of detection of sleep. From the author's own experience, one can also conclude that sleep applications are approximately as good as polysomnography in detection of sleep time, similar to the conventional wearable actimeters. In the future, sleep applications will help to further enhance awareness of sleep health and to distinguish those who actually poorly and only briefly sleep from those who suffer more likely from paradox insomnia. Copyright © 2016 Elsevier Inc. All rights reserved.

Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: a wake-up call for the pediatric critical care community*.

PubMed

Kudchadkar, Sapna R; Yaster, Myron; Punjabi, Naresh M

2014-07-01

To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children. An international, online survey of questions regarding sedative and analgesic medication choices and availability, sedation protocols, sleep optimization, and delirium recognition and treatment. Member societies of the World Federation of Pediatric Intensive and Critical Care Societies were asked to send the survey to their mailing lists; responses were collected from July 2012 to January 2013. Pediatric critical care providers. Survey. The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in PICUs with sedation scoring systems (70%), although only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. The State Behavioral Scale was the most commonly used scoring system in North America (22%), with the COMFORT score more prevalent in all other countries (39%). The most commonly used sedation regimen for intubated children was a combination of opioid and benzodiazepine (72%). Most intensivists chose fentanyl as their first-line opioid (66%) and midazolam as their first-line benzodiazepine (86%) and prefer to administer these medications as continuous infusions. Propofol and dexmedetomidine were the most commonly restricted medications in PICUs internationally. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Delirium screening was not practiced in 71% of respondent's PICUs, and only 2% reported routine screening at least twice a day. The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children as well as a paucity of sleep promotion and delirium screening in PICUs worldwide.

Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children: A Wake-up Call for the Pediatric Critical Care Community

PubMed Central

Yaster, Myron; Punjabi, Naresh M.

2014-01-01

Objective To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children. Design An international, online survey of questions regarding sedative and analgesic medication choices and availability, sedation protocols, sleep optimization, and delirium recognition and treatment. Setting Member societies of the World Federation of Pediatric Intensive and Critical Care Societies were asked to send the survey to their mailing lists; responses were collected from July 2012 to January 2013. Interventions Survey Measurements and Main Results The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in pediatric intensive care units (PICUs) with sedation scoring systems (70%), although only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. The State Behavioral Scale was the most commonly used scoring system in North America (22%), with the COMFORT score more prevalent in all other countries (39%). The most commonly used sedation regimen for intubated children was a combination of opioid and benzodiazepine (72%). Most intensivists chose fentanyl as their first-line opioid (66%) and midazolam as their first-line benzodiazepine (86%), and prefer to administer these medications as continuous infusions. Propofol and dexmedetomidine were the most commonly restricted medications in PICUs internationally. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Delirium screening was not practiced in 71% of respondent’s PICUs, and only 2% reported routine screening at least twice a day. Conclusions The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children, as well as a paucity of sleep

Associations of sleep disturbance with ADHD: implications for treatment.

PubMed

Hvolby, Allan

2015-03-01

Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also 'paradoxically' calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.

Sleep Duration and Waist Circumference in Adults: A Meta-Analysis

PubMed Central

Sperry, Susan D.; Scully, Iiona D.; Gramzow, Richard H.; Jorgensen, Randall S.

2015-01-01

Background: Previous research has demonstrated a relation between insufficient sleep and overall obesity. Waist circumference (WC), a measure of central adiposity, has been demonstrated to improve prediction of health risk. However, recent research on the relation of insufficient sleep duration to WC in adults has yielded inconsistent findings. Objectives: To assess the magnitude and the consistency of the relation of insufficient sleep and WC Methods: A systematic search of Internet and research databases using Google Scholar, Medline, PubMed, and PsycINFO through July 2013 was conducted. All articles in English with adult human subjects that included measurements of WC and sleep duration were reviewed. A random effects meta-analysis and regression analyses were performed. Heterogeneity and publication bias were checked. Results are expressed as Pearson correlations (r; 95% confidence interval). Results: Of 1,376 articles, 30 met inclusion criteria and 21 studies (22 samples for a total of 56,259 participants) provided sufficient data for meta-analysis. Results showed a significant negative relation between sleep duration and WC (r = −0.10, P < 0.0001) with significant heterogeneity related to sleep comparison method. Potential moderators of the relation between sleep duration and WC were not significant. Funnel plots showed no indication of publication bias. In addition, a fail-safe N calculation indicated that 418 studies with null effects would be necessary to bring the overall mean effect size to a trivial value of r = −0.005. Conclusions: Internationally, cross-sectional studies demonstrate a significant negative relation between sleep duration and waist circumference, indicating shorter sleep durations covary with central adiposity. Future research should include prospective studies. Citation: Sperry SD, Scully ID, Gramzow RH, Jorgensen RS. Sleep duration and waist circumference in adults: a meta-analysis. SLEEP 2015;38(8):1269–1276. PMID:25581918

Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer

PubMed Central

Palesh, Oxana; Peppone, Luke; Innominato, Pasquale F; Janelsins, Michelle; Jeong, Monica; Sprod, Lisa; Savard, Josee; Rotatori, Max; Kesler, Shelli; Telli, Melinda; Mustian, Karen

2012-01-01

Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer. PMID:23486503

Safe Use of Hydrogen and Hydrogen Systems

NASA Technical Reports Server (NTRS)

Maes, Miguel

2006-01-01

This is a viewgraph presentation that is a course for teaching the safe use of hydrogen. The objectives of the course are 1. To familiarize the student with H2 safety properties 2. To enable the identification, evaluations and addressing of H2 system hazards 3. To teach: a. Safe practices for, b. Design, c. Materials selection, d. H2 system operation, e. Physical principles and empirical observations on which these safe practices are based, f. How to respond to emergency situations involving H2, g How to visualize safety concepts through in-class exercises, h. Identify numerous parameters important to H2 safety.

Safe Practices for Copy and Paste in the EHR. Systematic Review, Recommendations, and Novel Model for Health IT Collaboration.

PubMed

Tsou, Amy Y; Lehmann, Christoph U; Michel, Jeremy; Solomon, Ronni; Possanza, Lorraine; Gandhi, Tejal

2017-01-11

Copy and paste functionality can support efficiency during clinical documentation, but may promote inaccurate documentation with risks for patient safety. The Partnership for Health IT Patient Safety was formed to gather data, conduct analysis, educate, and disseminate safe practices for safer care using health information technology (IT). To characterize copy and paste events in clinical care, identify safety risks, describe existing evidence, and develop implementable practice recommendations for safe reuse of information via copy and paste. The Partnership 1) reviewed 12 reported safety events, 2) solicited expert input, and 3) performed a systematic literature review (2010 to January 2015) to identify publications addressing frequency, perceptions/attitudes, patient safety risks, existing guidance, and potential interventions and mitigation practices. The literature review identified 51 publications that were included. Overall, 66% to 90% of clinicians routinely use copy and paste. One study of diagnostic errors found that copy and paste led to 2.6% of errors in which a missed diagnosis required patients to seek additional unplanned care. Copy and paste can promote note bloat, internal inconsistencies, error propagation, and documentation in the wrong patient chart. Existing guidance identified specific responsibilities for authors, organizations, and electronic health record (EHR) developers. Analysis of 12 reported copy and paste safety events was congruent with problems identified from the literature review. Despite regular copy and paste use, evidence regarding direct risk to patient safety remains sparse, with significant study limitations. Drawing on existing evidence, the Partnership developed four safe practice recommendations: 1) Provide a mechanism to make copy and paste material easily identifiable; 2) Ensure the provenance of copy and paste material is readily available; 3) Ensure adequate staff training and education; 4) Ensure copy and paste

Managers’ Practices Related to Work–Family Balance Predict Employee Cardiovascular Risk and Sleep Duration in Extended Care Settings

PubMed Central

Berkman, Lisa F.; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

2012-01-01

An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work–family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work–family balance score of manager openness and creativity in dealing with employee work–family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work–family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work–family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work–family score. Managers’ attitudes and practices may affect employee health, including sleep duration and CVD risk. PMID:20604637

Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.

PubMed

Berkman, Lisa F; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

2010-07-01

An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

Practice Parameters for the Use of Autotitrating Continuous Positive Airway Pressure Devices for Titrating Pressures and Treating Adult Patients with Obstructive Sleep Apnea Syndrome: An Update for 2007

PubMed Central

Morgenthaler, Timothy I.; Aurora, R. Nisha; Brown, Terry; Zak, Rochelle; Alessi, Cathy; Boehlecke, Brian; Chesson, Andrew L.; Friedman, Leah; Kapur, Vishesh; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J.

2008-01-01

These practice parameters are an update of the previously published recommendations regarding the use of autotitrating positive airway pressure (APAP) devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. Continuous positive airway pressure (CPAP) at an effective setting verified by attended polysomnography is a standard treatment for obstructive sleep apnea (OSA). APAP devices change the treatment pressure based on feedback from various patient measures such as airflow, pressure fluctuations, or measures of airway resistance. These devices may aid in the pressure titration process, address possible changes in pressure requirements throughout a given night and from night to night, aid in treatment of OSA when attended CPAP titration has not or cannot be accomplished, or improve patient comfort. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine has reviewed the literature published since the 2002 practice parameter on the use of APAP. Current recommendations follow: (1) APAP devices are not recommended to diagnose OSA; (2) patients with congestive heart failure, patients with significant lung disease such as chronic obstructive pulmonary disease; patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome); patients who do not snore (either naturally or as a result of palate surgery); and patients who have central sleep apnea syndromes are not currently candidates for APAP titration or treatment; (3) APAP devices are not currently recommended for split-night titration; (4) certain APAP devices may be used during attended titration with polysomnography to identify a single pressure for use with standard CPAP for treatment of moderate to severe OSA; (5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without

3 CFR 8524 - Proclamation 8524 of May 20, 2010. National Safe Boating Week, 2010

Code of Federal Regulations, 2011 CFR

2011-01-01

..., let us recommit during National Safe Boating Week to practicing safe techniques so boaters of all ages... awareness and teach safe boating practices. Boaters can take advantage of these opportunities to learn, make... activities to observe this occasion by learning more about safe boating practices and to take advantage of...

Latino Parents' Insight on Optimal Sleep for Their Preschool-Age Child: Does Context Matter?

PubMed

Martinez, Suzanna M; Thompson-Lastad, Ariana

2015-01-01

Insufficient sleep is a risk factor for pediatric obesity. Latino children are among those groups in which both short sleep duration and obesity are prevalent. Therefore, this study sought to explore Latino parents' views about ideal sleep duration and sleep-related practices for their preschool-age children in an urban setting. Between October 2013 and January 2014, Latino parents of 2- to 5-year-old children were interviewed at 3 pediatric clinics (San Francisco, Calif). Using a semistructured interview guide, parents were asked to describe bedtime routines and sleep practices of their preschool-age children, including behavioral, parental, social, and contextual factors that may affect children's sleep. Interviews were conducted in Spanish and English. Parents also completed a brief survey on demographic information. Interviews were analyzed on the basis of a priori and emergent themes. Latino parents (n = 18) were mostly female, with a mean age of 31 years; most were foreign born; and more than half had a monthly household income of $2000 or less. The following themes emerged: parents' ideas about optimal sleep duration for their preschool-age child, consistent bedtime routines, room sharing and bed sharing, parent work and child school schedules that affect children's sleep, and crowded housing and neighborhood noise that disrupt children's sleep. These findings increase our understanding of the factors related to achieving optimal sleep duration among Latino children living in urban and often crowded housing. Findings could be used to inform future research on how to increase parental knowledge of healthy sleep practices and adequate sleep among Latino parents of young children. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Social Stressors at Work, Sleep, and Recovery.

PubMed

Pereira, Diana; Gross, Sven; Elfering, Achim

2016-03-01

Many employees in service work are required to work on Saturdays, recovering during work-free Sundays and working again Mondays. We examined the effects of social stressors at work on recovery status at Sunday noon and Monday noon, and investigated if sleep quality mediates the negative effects of social stressors at work on recovery. From Saturday until Monday morning, 41 participants wore actigraphs to measure sleep duration and sleep fragmentation. Social stressors at work were assessed by self-reported questionnaires administered on Saturday. Recovery status was reported Sunday noon and Monday noon. Hierarchical regression analysis revealed that social stressors at work were negatively related to recovery status on Sunday and on Monday. Supporting our assumptions, more social stressors at work predicted higher sleep fragmentation in the night to Monday. A mediation effect of sleep quality, however, was not found. Theoretical and practical implications of these results are discussed.

Qualitative Assessment of Pregnant Women’s Perceptions of Infant Sleep Boxes

PubMed Central