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To examine the association between sleep pattern regularity and measures of weight and length in infants.This was a prospective observational study conducted in a university-affiliated children's hospital in northern Taiwan. A total of 316 healthy infants recruited during their 6-month well-child checkups had their weight and recumbent length measured, and wore an actigraph on the ankle for a week. Based on average weekday, weekend, and all-week sleep durations, infants were categorized into 3 groups: regular sleep, weekend catch-up sleep, and weekend sleep curtailment. General linear model analyses were performed with the 3 sleep regularity groups as the primary predictor variable of interest and infant anthropometry as the dependent variable.At risk of overweight, overweight, and obese was present in a total of 62 (19.6%) infants. In both unadjusted and adjusted models, infants in the weekend catch-up sleep group (30.4%) and those in the weekend sleep curtailment group (34.5%) had significantly higher weight-to-length ratios, body mass index, weight-for-age z-scores, and weight velocity of 6-month increments z-scores when compared with infants in the regular sleep group (35.1%, all p 0.05).Differences in weekday-weekend sleep exist as early as in the first 6 months of life, and both catch-up sleep and sleep curtailment over the weekend is associated with higher measures of weight and length in infants.Sleep assessments in well-child checkups should include not only global assessments of average sleep duration but also address sleep patterns and their regularity.

Introduction Sleep disturbances are commonly reported by parents of children and adolescents with epilepsy. However, evidence synthesis including quality and quantity of sleep in parents of children and adolescents with epilepsy is lacking. A greater understanding of the characteristics of sleep patterns and sleep problems in parents of children with epilepsy is needed because when the sleep of the parents is compromised, the parents’ ability to provide quality care for the child may be hampered. The purpose of this systematic review and meta-analysis was to synthesize published studies examining sleep and its disturbance in parents of children and adolescents with epilepsy. Methods Five electronic databases, PubMed, Medline, Embase, PsychINFO, and CINAHL, were systematically searched from inception to September 2021. Studies examining parents or caregivers of pediatric patients aged < 18 years with epilepsy using a quantitative measure of sleep duration, sleep quality, or sleep disturbance were included. Available data were pooled using random-effects or fixed-effects models on the basis of heterogeneity between studies. Results Eleven observational studies with a total of 934 parents of children and adolescents with epilepsy were reviewed. The pooled nocturnal sleep duration was only 5.93 hours (95% CI: 4.64 to 7.21 hours). Overall sleep quality as estimated by the bias-adjusted pooled Pittsburgh Sleep Quality Index total score was 6.65 (95% CI: 5.98 to 7.33). Parents of children with epilepsy had significantly higher Pittsburgh Sleep Quality Index total scores in comparison to parents of healthy children (differences in means: 1.84, 95% CI: 1.29 to 2.39). The pooled estimated prevalence of parental sleep disturbances was 58.1% (95% CI: 45.7% to 69.6%). Conclusion Our findings demonstrate a high prevalence of sleep disturbances with poor sleep quality and substantial reductions in sleep time in parents of children and adolescents with epilepsy. Healthcare professionals in pediatric neurology clinics should initiate screening of sleep disturbances in parents and refer parents to a sleep specialist when necessary. Support (if any) This work was supported by Ministry of Science and Technology, Taiwan, MOST 110-2628-B-002-039.

Guided respiration mindfulness therapy (GRMT) is a clinical model of breathwork that has shown promise as a treatment for depression, anxiety, and stress. This study examined the effectiveness of GRMT as a holistically oriented intervention for reducing psychological distress in nurses. Sixty-two nurses were assigned to either five sessions of GRMT or 5 sessions of a mindfulness-based intervention (MBI) comparison condition which were conducted over 5 weeks. A no-treatment control was also included. Session-by-session change in depression, anxiety, and stress, along with change in mindfulness and self-compassion were assessed. Multilevel analysis showed GRMT resulted in statistically significant reductions in overall psychological distress, anxiety, and stress levels, as well as significant increases in mindfulness and self-compassion with large to very large effect sizes. On all measures, GRMT performed better than the comparison MBI intervention which showed no significant effect on stress levels. Results suggest that GRMT can provide nurses with an effective group intervention for reducing stress, and increasing mindfulness and self-compassion which are foundational elements of self-care for the holistic nurse.

The purpose of this study was to explore the experiences of nurses who applied Swanson's Caring Theory to assist coping in a family of an infant with CHARGE Syndrome. The patient was born with multiple organ hypoplasia and was diagnosed using genetic testing with CHARGE syndrome. The shock and sadness, coupled with returning home for care and the long and endless journey of rehabilitation, were the most significant challenges and pressures for the parents when taking care of the patient. The author used interviews, texting apps, and observations to collect data, and completed the recording process between September 21st and December 3rd, 2020. Based on the data, the primary nursing problem was caregiver role strain. The process of nursing was summarized as (1) the impact stage, when the family first faces the child's diagnosis of a rare disease; (2) the transition stage from the hospital to the home in the care situation; and (3) the re-impact stage when the child experiences developmental delays. Swanson's Caring Theory was applied in this study to guide nursing care. The five caring processes outlined in Swanson's Caring Theory include knowing, being with, doing for, enabling, and maintaining belief. The authors used these caring processes at every stage to provide an individualized caring plan that included attentively listening to parents' ideas, encouraging parents to express personal perceptions, providing strategies to enhance parents' caring skills, and establishing positive beliefs to improve confidence. Nursing personnel may apply Swanson's Caring Theory to assist families of children with rare diseases to not only gain positive beliefs in a grieving situation but also achieve a rewarding life.運用Swanson關懷理論協助家庭面對嬰兒診斷CHARGE症候群之衝擊及護理經驗.本文描述運用Swanson關懷理論協助家庭面對嬰兒診斷CHARGE症候群之衝擊及護理經驗。個案出生即有多重器官發育不全，透過基因檢測確診為CHARGE症候群。震驚悲傷的情緒加上返家照護和漫長的復健之路，是父母照護個案時面臨的最大挑戰及壓力。護理期間自2020年9月21日至2020年12月3日，筆者透過當面會談、通訊軟體聯繫及觀察等方式收集資料並撰寫成行為過程紀錄，確立主要健康問題為照顧者角色緊張，並將護理過程歸納成：(1)家庭面對孩子診斷罕見疾病的衝擊期，(2)照護情境自醫院至居家的過渡期，(3)孩子發展遲滯的再衝擊期。以Swanson關懷理論為護理照護指引，運用關懷理論中之「了解」、「在旁陪伴」、「為他做某些事」、「使他能夠」與「維持信念」的五大關懷核心於照護各階段並提供個別性之護理措施，傾聽父母內心的感受與鼓勵其情感的抒發，衛教相關因應策略提升父母照護的能力及建立正向之信念，緩解照顧者緊張之情緒，進而有信心勝任照顧者的角色。罕病兒家庭歷經疾病威脅與痛苦打擊，以關懷理論為基礎提供護理照護，可以協助家庭與照顧者在悲傷情境中找到能量，譜出不同的生命故事。.

To examine the association between daily screen time exposure and both sleep patterns (sleep onset, sleep offset, and nighttime, and daily sleep durations) and sleep disturbances among a clinical sample of children with epilepsy.A cross-sectional actigraphic sleep study.A convenience sample of 141 children with epilepsy (1.5-6 years of age) was recruited from an outpatient pediatric neurology clinic of a university-affiliated children's hospital in northern Taiwan. Participating families completed questionnaires and reported children's screen time use, with children wearing an actigraphy monitor for 7 days to assess sleep patterns. Multivariable linear regression analyses were conducted to examine the association of screen time exposure with the child's sleep patterns and sleep disturbance scores.Mean minutes per day of screen time exposure was 89.79 ± 83.94 min, with 62 parents (44.0%) reporting their child having1 hr of screen time daily. Mean daily sleep duration was 9.26 ± 1.01 hr, with 106 children (93.0%) sleeping10 hr in a 24-hr period. In multivariate regression models, daily screen time exposure of1 hour was associated with 23.4-min later sleep onset (b = 0.39, p = .02), 20.4-min later sleep offset (b = 0.34, p = .04), and more severe sleep disturbances (b = 2.42, p = .04).In toddlers and preschool-age children with epilepsy, daily screen time exposure is greater and sleep duration is shorter than the recommended amount, with increased screen time exposure associated with disturbed sleep.Parents need to be informed about the possible adverse impact of screen time exposure on children's sleep and health as well as the importance of limiting screen time exposure to1 hr per day for their toddlers and preschool-age children with epilepsy.

Epilepsy is one of the most common chronic neurological diseases in children. Sleep disorders tend to increase the risk of seizures, and research has found that moderate physical activity may improve the quantity and quality of sleep in adults. However, the link between physical activity level and sleep patterns in toddlers and preschool-age children with epilepsy remains unclear.To explore the association between level of physical activity and sleep patterns in toddlers and preschool-age children with epilepsy.A cross-sectional, descriptive, correlational study was conducted. Ninety-eight children with epilepsy (1.5-6 years old) wore an actigraph for seven days. Additional data were collected using a health information datasheet, Children's Sleep Habits Questionnaire (CSHQ), and sleep diary, all of which were completed by the parents of each child.The results showed that the mean amount of time spent in moderate-to-vigorous physical activity per day was 36.00 ± 49.20 minutes and that only 23 children (23.5%) had a nighttime sleep efficiency greater than 85%. The overall CSHQ score (56.00 ± 5.69) indicated the presence of moderate to severe sleep disturbances. Multiple regression analysis showed the hours and percentage of moderate-to-vigorous physical activity to be positively associated with night sleep efficiency (β = .54, p.01; β = .51, p.01) and negatively associated with nighttime sleep hours (β = -.55, p.01; β = -.52, p.01), even after controlling for potential confounders.Based on the findings, the sleep patterns and physical activity of children with epilepsy should be regularly assessed. Furthermore, appropriately increasing the duration of moderate-to-vigorous physical activity may improve sleep efficiency and prevent reductions in the duration of night sleep.癲癇兒童日間活動與睡眠型態相關性之探討.癲癇症是兒童最常見的慢性神經系統疾病之一，睡眠障礙易使癲癇發作機會增加，成人研究顯示適度身體活動有益睡眠，但目前不清楚幼兒及學齡前癲癇兒身體活動與睡眠型態之關係。.探討幼兒期及學齡前期癲癇兒身體活動與睡眠型態之相關性。.採橫斷式描述相關性設計，共98位1.5–6歲癲癇兒連續七日佩戴活動記錄器，其父母完成癲癇兒童基本健康資料表、兒童睡眠習慣問卷（Children’s Sleep Habits Questionnaire, CSHQ）及癲癇兒童睡眠活動日誌。.癲癇兒平均每日中高度身體活動時數為36.00 ± 49.20分鐘，夜間睡眠效率85%僅23人（23.5%），CSHQ總分（56.00 ± 5.69）顯示有中至重度睡眠問題。多元迴歸分析在控制干擾因子後，中高度身體活動時數、百分比與夜間睡眠效率呈顯著正相關（β = .54, p.01; β = .51, p.01）；與夜間睡眠時數呈顯著負相關（β = -.55, p.01; β = -.52, p.01）。.依研究結果建議常規評估癲癇兒身體活動與睡眠，適度增加中高度身體活動進而提升睡眠效率及避免縮短夜間睡眠時數。.

Background Fatigue and poor sleep are two of the most common and most distressing symptoms for adolescents with cancer. These 2 symptoms concurrently heighten distress, further decreasing quality of life (QoL). Objectives The aims of this study were to describe the degree of exercise involvement, fatigue, sleep quality, and QoL among adolescents with cancer and to determine whether exercise mediates the relationships between (a) fatigue and QoL and (b) sleep quality and QoL. Methods A cross-sectional study of 100 participants was conducted. Multiple regression was performed to examine the mediation relationship. Results Participants in the off-treatment group had a significantly higher degree of exercise involvement, as well as less fatigue, greater sleep quality, and less QoL distress. Exercise partially mediated the adverse effect of fatigue on QoL for adolescents undergoing cancer treatment, accounting for 49.80% of the total variation; exercise partially mediated the adverse effect of poor sleep on QoL for adolescents both in treatment and in survivorship, accounting for 42.06% and 28.71% of the total variations, respectively. Conclusion Exercise partially mediated the relationship between fatigue and QoL for adolescents in cancer treatment and partially mediated the relationship between sleep quality and QoL both for those in cancer treatment and for those in survivorship. Implications for practice Developing tailored exercise programs based on both treatment status and the degree of fatigue and sleep quality is important. In-service education that enhances nurses' awareness of the importance of exercise in improving adolescents' QoL is recommended.

Introduction Limited studies have examined sleep variability in children with overweight and obesity, nor do studies focused on its relation with behavior outcomes in this high risk pediatric population. The purpose of this study was to examine sleep duration and its variability in relation to behavior outcomes in school-age children with overweight and obesity. Methods Sleep in 246 children aged 6-9 years with overweight and obesity was assessed using actigraphy for 7 days and through the parent-report Children’s Sleep Habits Questionnaire (CSHQ). Children’s behaviors were assessed using parental responses on the Behavior Assessment for Children. Children were categorized into 4 groups based on the median split of the average daily sleep duration and its variability: sufficient-stable, sufficient-variable, insufficient-stable, and insufficient-variable. General linear model (GLM) analyses were performed with the 4 sleep groups as the primary predictor variable and child behavior outcomes as the dependent variable. Results Average daily sleep duration by actigraphy was 7.52 hours, with 84.6% of the children having clinically significant CSHQ sleep disturbance scores and 68.3% having a total behavior problem score in the clinical range. In the unadjusted and adjusted GLM analysis, children in the insufficient-stable sleep duration category had significantly higher emotion problem (p < 0.05), self-control problem (p < 0.01), and total behavior problem scores (p < 0.01) when compared with those in the sufficient-stable sleep duration (reference) category. Children in the insufficient-variable sleep duration category had significantly higher self-control problem scores when compared with those in the reference category (p < 0.05). Conclusion School-age children with overweight and obesity coexist with sleep and behavior problems, with those who have persistent short sleep at the greatest risk for the worst behavior outcomes. Support (If Any) This work was supported by Ministry of Science and Technology, Taiwan, MOST 107 - 2314 - B - 002 - 025 - MY3.

AIMS To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability. DESIGN This was a prospective observational study conducted between November 2012 and November 2016. METHODS Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. RESULTS One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b = -23.55, p

Introduction Sleep plays a crucial role in children’s health and development, and emerging evidence suggests that sleep disturbances during infancy negatively impact both the neurocognitive and socioemotional outcomes later in life. However, no study has taken the variability of sleep into account when examining physical growth in infancy, which is a critical period for both healthy sleep and weight development. The purpose of the study was to examine the association between sleep variability and physical growth in infants aged 6 months. Methods 316 healthy infants recruited during their 6-month well-child checkups had their weight and length measured, and wore an actigraph on the ankle for a week. Average weekday, weekend, and all week sleep duration were computed, with infants categorized into three groups: regular sleep, weekend catch-up sleep, and weekend sleep curtailment. General linear model analyses were performed with sleep variability as the primary predictor variable of interest and infant anthropometry as the dependent variable. Results Average weekday daily sleep duration was 10.76 (1.06) hours which was similar to the average weekend daily sleep duration of 10.68 (1.06) hours. In both unadjusted and adjusted models controlling for potential confounding variables, infants in the weekend catch-up sleep group (30.4%) and those in the weekend sleep curtailment group (34.5%) had significantly higher weight-to-length ratios, body mass index, and weight-for-age z scores when compared with infants in the regular sleep group (35.1%, all p < 0.05). Conclusion Weekday-weekend sleep pattern differences exist even as early as in the first 6 months of life, and either weekend catch-up sleep or weekend sleep loss is associated with higher infant anthropometric markers. Our findings suggest that sleep assessments in infants in well-child checkups should include not only global assessments of average sleep duration but also address sleep pattern regularity. Support (if any) This study was funded by the National Health Research Institutes, Taiwan, NHRI-EX102-10229PC.

The nursing profession plays an important role in health promotion and care services and works with other healthcare disciplines to improve public health around the world (International Council of Nurses, 2018). 2020 is of great significance to nurses globally because it marks the 200th birthday of Florence Nightingale, the founder and pioneer of modern nursing. To recognize nursing's contribution to and impact on the international community, the World Health Organization designated 2020 as the "International Year of the Nurse and the Midwife" (World Health Organization, n.d.), with goals set to further promote nursing as a profession with a global vision and strengths for growth and internationalization. In step with globalization trends, the nursing profession in Taiwan has established partnerships with multiple international organizations and overseas education institutions. Furthermore, supported by the framework of Taiwan's New Southbound Policy, Taiwan's professional nursing community has taken an increasingly important and leading role in nursing education and academic research in the Asia-Pacific Region. Technology has enabled the nursing profession to transition relatively quickly to the needs and realities of globalization. Nursing-led research teams have become increasingly actively involved in collaboration with international researchers who share the same research interests to identify and solve health problems around the globe and to generate nursing knowledge that is valid for use across multiple cultural settings. Globalization and technology have given professional nursing services greater international recognition and appreciation. They also provide the nursing profession with opportunities to adapt and streamline traditional care models in order to best utilize nursing care services and healthcare resources. With the assistance of modern technology, healthcare services are increasingly digital and mobile, allowing nursing assessments and medical arrangements to be conducted efficiently and with significantly less wait times. Technological advancements have significantly expanded the delivery of nursing care and improved the feasibility of cross-setting and cross-border health-service collaboration. Nursing has a significant and global impact, with local, national, and international nursing communities working together to achieve United Nation's sustainable development goals (Dossey, Rosa,Beck, 2019). According to the World Health Organization, at least nine million nursing professionals will be needed globally by 2030 (World Health Organization, 2020). The internationalization of nursing education, research, and practice is set to create unlimited, global opportunities for the future development of nursing.全球化世界中的護理專業.護理專業在全世界各國之健康促進及照護服務中均扮演重要角色，並與其他領域之醫療從業人員共同守護全民健康（International Council of Nurses, 2018）。今年2020年對全球護理人員而言極具意義，為護理鼻祖南丁格爾女士200歲之冥誕，世界衛生組織基於護理專業對於國際社會之影響力，更訂立今年為國際護理師與助產師年（World Health Organization, n.d.），加速驅動護理成為具有全球視野及國際發展優勢之專業。近年臺灣護理專業因應全球化之潮流也逐步與國際接軌，國內護理教育隨國家新南向政策開始積極於全球佈局，開拓前所未有之臺灣護理教育世界版圖，更在亞太地區之護理教育及學術研究佔有領導地位，臺灣在未來全球護理人才養成及培育上將開始佔有一席之地。科技也使得護理專業更快速進入全球化的時代，護理為主導的研究團隊開始積極投入並與國際相同研究領域者合作，共同發現及改善全球健康問題，並創造跨文化護理新知作為教育及實證之基礎。全球暨科技化使護理專業服務受到更多的國際認可及肯定，並使護理專業有機會調整傳統之照護模式，讓護理專業及資源能更精準的被運用。科技輔助也使護理照護更加數位化及智慧化，透過行動網路可將社區中個案的健康資料與醫療端連結，使數據判讀及評估和處置安排更有效率，提升護理專業功能之發揮及多元跨國照護服務之可近性。護理專業正在全球各地發揮舉足輕重之影響力，將共同為聯合國永續發展目標而努力（Dossey, Rosa,Beck, 2019），世界衛生組織預測至2030年全球將需要至少九百萬名護理專業人員（World Health Organization, 2020），護理教育研究及實務之國際化將為護理未來的全球發展開創無限契機。.

PURPOSE To examine the association between snoring, sleep quality, quantity, and blood pressure in third-trimester normotensive pregnant women. DESIGN This study was a cross-sectional analysis of two cohorts of healthy pregnant women recruited from a prenatal clinic in a medical center in Northern Taiwan. METHODS A total of 322 women reported sociodemographic and health characteristics in a structured interview and wore a wrist actigraph on their nondominant wrist for 7 consecutive days to assess objective sleep patterns. The women's resting blood pressures were measured while seated in the clinic by trained personnel using an electronic sphygmomanometer. FINDINGS One hundred thirty-three (41.3%) women reported snoring. Ninety-three women (28.9%) had

Purpose To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings. Design Cross-sectional study. Methods Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends. Findings Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent. Conclusions Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary. Clinical relevance Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.

Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption.To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.A prospective observational cohort study.204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups.121 (59.3%) 1st trimester women had a sleep efficiency of85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively.Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.

Aims and objectives To explore the perceptions and experiences of parental professional help-seeking for infant sleep and sleep-related concerns. Background Infant sleep is a frequent concern for parents. However, very little is known about the reasons parents seek, do not seek or delay seeking professional attention about their concerns related to infant sleep. Design and methods A qualitative study design was used. Twenty audio-taped interviews with parents of healthy 12-month-old infants were conducted at a university-affiliated hospital or parents’ homes depending on where parents felt more comfortable discussing their personal views and medical help-seeking experiences. Thematic content analysis was performed to determine specific patterns and similarities within and between interview data. Findings Three main themes developed from the interviews were as follows: (i) uncertainty about infant sleep; (ii) I can handle infant sleep; and (iii) I am not satisfied with the professional services provided for infant sleep. Overall, parents knew little about or misunderstood infant sleep behaviours. Lack of proper information and knowledge about infant sleep influenced parents’ motivation for professional help-seeking and help-receiving. Parents who have consulted a healthcare professional but received unsatisfactory responses, such as an ambivalent attitude or insufficient assessment, reported being less motivated or unwilling to seek medical help again. Conclusion Our study demonstrates the complexity of parental professional help-seeking and receiving for infant sleep. Findings suggest that parents perceive a wide range of barriers that influence the likelihood that they will seek professional advice for infant sleep. Relevance to clinical practice Reducing knowledge barriers and providing adequate attention at all well-infant visits would facilitate parental use of healthcare services to manage problematic infant sleep behaviours.

Aims To examine the sleep characteristics of infants with parentally reported sleep problems, with parentally reported no sleep problems and with parentally reported uncertain sleep conditions. Background Infant sleep problems are recognized as a major health issue worldwide. However, in our daily clinical practices it is not uncommon for parents not to know whether their infant sleep is problematic. Design and Methods A prospective study conducted between 2012 - 2015 where 219 parents completed questionnaires and infants wore an actigraph monitor for 7 days. Multinomial logistic regression models were used to evaluate the actigraphic and parentally reported infant sleep behaviors between the groups. Results Thirty-two (14.61%) parents did not know whether their infant sleep was problematic and 118 (53.88%) parents considered their infant sleep a problem. Compared with infants without sleep problems, infants with uncertain sleep conditions had significantly increased odds of having shortened longest sleep duration according to parental report. A significant association was found for infants without sleep problems compared with those with sleep problems who had significantly more wake after sleep onset as measured by actigraphy, as well as reduced longest sleep duration according to parental report. Conclusion Infants with uncertain sleep conditions have the same problematic sleep behaviors resembling those of children with reported sleep problems. Healthcare professionals should actively disseminate sleep knowledge to help parents interpret infant sleep behaviors and consider possible intervention strategies for improving parental sleep-related knowledge and infant sleep. This article is protected by copyright. All rights reserved.

Daytime sleepiness is a frequent complaint in women during pregnancy. It has also been linked to negative obstetric consequences. Although high prevalence of excessive daytime sleepiness throughout pregnancy is well-documented, neither the causes of persistent daytime sleepiness nor new-onset daytime sleepiness during pregnancy have been investigated. Identifying predictive factors may play an important role in the management of daytime sleepiness in pregnant women and improve prenatal care and maternal-fetal outcomes.To examine first-trimester maternal characteristics associated with the persistence and new-onset daytime sleepiness in pregnant women.A longitudinal, prospective cohort design.One medical center in Taipei, Taiwan and participating women's homes.A total of 204 pregnant women.First-trimester pregnant women recruited from an outpatient obstetric clinic at a medical center provided socio-demographic and health information, wore an actigraphy monitor for 7 days, and completed sleep, mood, and daytime sleepiness questionnaires. Data were collected again when the women were in the second and third trimester.Thirty-one (15.2%) women experienced excessive daytime sleepiness that persisted across all three trimesters. Nulliparous women and women who snored in the first trimester were 2.28 and 2.10 times more at risk of being classified of persistent daytime sleepiness than multiparous women and women who did not snore in the first trimester, respectively. Thirty-one (15.2%) women developed new-onset daytime sleepiness with advancing gestation. Women were more likely to develop new-onset daytime sleepiness if they worked longer hours per week (OR=1.04, p0.001), if they reported snoring (OR=6.75, p0.001), and if they had elevated depressive symptoms in the first trimester of pregnancy (OR=1.09, p=0.01).Snoring in the first trimester is involved in both the persistence and new-onset of daytime sleepiness with elevated depressive symptoms related to new-onset daytime sleepiness in pregnant women. Findings suggest that intervention strategies for alleviating daytime sleepiness in pregnant women should focus on managing snoring and symptoms of depression in early trimesters with special attention to nulliparous and employed women.

We conducted a cross-sectional study to examine sleep in mothers of children with epilepsy and its relation to their children's sleep. A total of 133 dyads of mothers and children with epilepsy aged 1.5-6 years were recruited between 2015 and 2018 from a children's hospital in northern Taiwan. Participating families provided demographic and health information, with children wearing an actigraphy monitor for 7 days and mothers completing sleep and depressive mood questionnaires. We found that 76 (57.1%) of the mothers had poor sleep quality, with 65 (48.9%) mothers having a clinically significant depressive symptom score. Mean actigraphic wake after sleep onset in children was 1.42 (standard deviation = 0.51) hours, with 126 (94.7%) of the children having a clinically significant sleep disturbance score. Multivariate regression analyses showed that higher depressive symptom scores in mothers (β = 0.14; p < .01) and higher sleep disturbance scores in children (β = 0.07; p = .04) were associated with poorer maternal sleep quality, even when maternal demographic characteristics and the child's clinical and epilepsy variables were considered. Findings from our study suggest that sleep disturbances are a shared problem for mothers and their children with epilepsy. Sleep in both mothers and their children with epilepsy should be evaluated in pediatric neurologic practices, with maternal depressive symptoms screened concurrently. Future pediatric epilepsy studies are warranted to examine whether a family-based intervention program would be effective to improve sleep in mother-child dyads and to promote better health and functioning of the entire family.

Study ObjectivesTo evaluate the effect of a clinic-based, behavioral-educational sleep intervention on sleep of children with epilepsy, maternal knowledge about childhood sleep, and maternal sleep quality.MethodsA total of 100 toddlers and preschool-age children with epilepsy (1.5–6 years, 55% boys) and their parents were randomized to receive sleep intervention (n = 50) or usual care with attention (n = 50). Outcomes were assessed at baseline, 3, 6, and 12 months after intervention with the use of objective actigraphy, Children’s Sleep Habits Questionnaire, Parents’ Sleep Knowledge Inventory, and Pittsburgh Sleep Quality Index. Intervention effects were examined using general linear models for repeated measurements to compare the mean change in outcomes from baseline to 12 months post-intervention between the two groups.ResultsSleep intervention resulted in children having greater sleep efficiency by 2.03% compared with the usual care group (95% CI = 0.20% to 3.86%; p = .03). Children in the intervention group also had significantly longer total nighttime sleep as objectively assessed by actigraphy than did those in the usual care group, with an adjusted mean difference of 16.13 minutes (95% CI = 0.24% to 32.03%; p = .04). No intervention effects were observed for maternal knowledge about childhood sleep, and maternal sleep quality.ConclusionSleep intervention provided during routine neurologic visits results in significant, measurable, and sustained benefits in sleep quality and quantity in children with epilepsy. Future trials are warranted to evaluate whether improvements in sleep could impact health-related quality of life or other aspects of functioning in children with epilepsy.Clinical TrialThis trial has been registered at www.clinicaltrials.gov (trial name: Sleep Intervention for Pediatric Epilepsy; registration number: NCT02514291).

We evaluated the psychometric properties of a Mandarin Chinese version of the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) in pregnant women. A total of 228 first-trimester pregnant women participated in the study, which was conducted in an outpatient obstetric clinic at a medical center in Taipei, Taiwan. The Chinese version of the FOSQ-10 demonstrated satisfactory internal consistency (Cronbach alpha = .85), adequate corrected item-total correlations (from .40 to .67), and acceptable test–retest reliability over 7 days (ICC = .73). Construct validity was supported by exploratory factor analysis showing a one-factor structure with item loadings between .49 and .77. Significant associations with the Medical Outcomes Study Short-Form Health Survey 12 version 2 and Pittsburgh Sleep Quality Index supported criterion-related and convergent validity. Significant differences in the Chinese version of the FOSQ-10 total scores were found between women with clinically significant daytime sleepiness and those without, suggesting adequate discriminant validity. Ceiling effects were observed for all items, but no floor or ceiling effects were found for total scores. Findings suggest that the Chinese version of the FOSQ-10 is a valid and reliable instrument to identify important effects of sleep-related impairment in Chinese women during pregnancy. Further testing is needed in more diverse pregnant women, such as women with complicated pregnancies and those with sleep disorders. © 2016 Wiley Periodicals, Inc.

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

Introduction Sleep disturbances are one of the most frequent complaints identified during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide. The purpose of this study was to examine the predictive association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women. Methods We recruited 204 first-trimester pregnant women from a large university-affiliated hospital. They provided baseline socio-demographic and health information, wore a wrist actigraph for 7 days, and completed the Pittsburgh Sleep Quality Index and Center for Epidemiologic Studies - Depression Scale and repeated this again in the second and third trimesters. Each data collection was scheduled at least 8 weeks apart. Unadjusted and multivariable adjusted odds ratios with 95% confidence intervals were used to evaluate sleep disturbances at 1st trimester and risk of high depressive symptoms at follow-up. Results A total of 121 (59.3%) women had actigraphic sleep efficiency of < 85% and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.65-, 3.86-, and 5.27-fold increased odds having risk of high depressive symptoms at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. No subjective sleep disturbance variables were significantly associated with risk of high depressive symptoms in multivariate adjusted models. Conclusion Objectively assessed poor sleep efficiency in the 1st trimester plays a crucial role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether early interventions to improve sleep may help reduce high depressive symptom risk and lower depression rates in women during pregnancy. Support This study was funded by the Ministry of Science and Technology, Taiwan (MOST-101-2314-B-002-049-MY3).

Study objectives To examine maternal knowledge of childhood sleep and its relation to sleep quantity, quality, and variability in a clinic sample of mothers of toddlers and preschool-age children with epilepsy. Methods A total of 112 epileptic children wore a wrist actigraphy to objectively assess daily sleep duration and its variability across 7 days. Mothers completed the Parents' Sleep Knowledge Inventory and Children's Sleep Habits Questionnaire (CSHQ). Multivariate linear regression models were performed to predict CSHQ sleep disturbance scores, daily sleep duration, and daily sleep duration variability in children with epilepsy. Results On average, mothers answered 30.5 per cent of the questions correctly about normal childhood sleep patterns. Only six (5.3%) of the mothers answered half or more of the questions correctly. Mothers more frequently answered "don't know" to questions about dreams, symptoms of sleep-disordered breathing, and adequate amounts of sleep required by children and adolescents. After adjusting for the child's age, gender, bed-sharing, and relevant clinical and epilepsy variables, poorer maternal sleep knowledge was the independent predictor of higher CSHQ sleep disturbance scores and greater intraindividual variability of daily sleep duration in epileptic children (p Conclusions Maternal knowledge about childhood sleep is inadequate and decreased maternal sleep knowledge is associated with poorer and more variable sleep in children with epilepsy. Findings from this study document the need to provide parental education about childhood sleep, particularly emphasizing the recommended sleep duration for children across different developmental stages and addressing the symptoms of sleep disorders commonly comorbid with epilepsy. Trial registration This trial has been registered at www.clinicaltrials.gov (trial name: Sleep Intervention for Pediatric Epilepsy; registration number: NCT02514291).

Sleep disturbances and hypertension are common health issues in patients with systemic lupus erythematosus (SLE). Limited information is available regarding the objective sleep quality and the variation of diurnal blood pressure (BP) in patients with SLE. Moreover, the relationship between sleep patterns and diurnal BP variation in SLE patients is not clear.To explore the subjective/objective sleep patterns and the diurnal BP variation in women with SLE, to identify the factors associated with diurnal BP variation, and to identify the predictors of this variation.A cross-sectional, descriptive, correlational study was conducted and 42 women with SLE were recruited. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, and Brief Pain Inventory. Rheumatologists rated current lupus disease activity. Additionally, the participants wore a wrist actigraph for 7 consecutive days and underwent 24h ambulatory BP monitoring for one day.The mean Global PSQI score was 7.74 ± 3.21; 69% of the participants reported poor subjective sleep quality; the actigraphy-measured sleep efficiency was 85.29 ± 5.95%; and 42.9% had poor objective sleep quality. Total sleep time at night was positively associated with diurnal change in diastolic BP (r = .315. p.05) and pain severity was negatively associated with diurnal change in systolic BP (r = -.430, p.01) and diastolic BP (r = -.371, p.05). Multiple linear regression analysis was used to predict diurnal BP variation. Moreover, pain was a significant predictor of diurnal change in systolic BP (β = -0.397, p.01) and diurnal change in diastolic BP (β = -0.325, p.05).The findings of the present study suggest that healthcare professionals should routinely evaluate sleep quality and pain in SLE patients. Improving both the poor sleep and pain management of these patients is clinically important. Further studies of the association between pain management and diurnal BP variation are needed.全身性紅斑性狼瘡女性睡眠與晝夜血壓相關性及預測因子之初探.全身性紅斑性狼瘡（systemic lupus erythematosus, SLE）病患常主訴有睡眠困擾及合併高血壓，但缺乏客觀睡眠型態評估及探討SLE晝夜血壓變化的情形，也尚未有研究探討SLE睡眠型態與晝夜血壓的關係。.探討SLE女性主、客觀睡眠型態與晝夜血壓變動之相關性，並找出預測晝夜血壓變動之因素。.採橫斷式描述相關性設計，共納入42位SLE女性，受試者完成匹茲堡睡眠品質量表、醫院焦慮憂鬱量表、疼痛量表，並由風濕科醫師評估疾病活動度；另佩戴腕動計連續7日及24小時血壓計1日。.匹茲堡睡眠品質量表平均總分為7.74 ± 3.21，主觀睡眠品質不良佔69%，佩戴腕動計測得睡眠效率85.29 ± 5.95%，42.9%為客觀睡眠品質不良。夜間睡眠總時數與舒張壓晝夜下降幅度（r = .315, p.05）呈正相關，疼痛指數則與收縮壓（r = -.430, p.01）及舒張壓（r = -.371, p.05）之晝夜下降幅度呈負相關，以多元迴歸分析後疼痛亦分別為收縮壓（β = -0.397, p.01）及舒張壓（β = -0.325, p.05）之晝夜下降幅度之顯著預測因子。.根據研究結果，建議醫護人員常規評估SLE病患的睡眠及疼痛，除了改善睡眠欠佳的情形，也可協助擬定減緩疼痛之計畫。未來可對於疼痛改善與晝夜血壓下降幅度之關係進一步探討。.

We designed a cross-sectional study to examine the association between sleep and behavior problems in toddlers and preschool-age children with epilepsy. We found that 71 (78.9%) children slept less than 10 hours in a 24-hour period according to the actigraphy, with 75 (83.3%) children waking for more than an hour during nocturnal sleep. Twenty-five (27.8%) children usually or sometimes had an inconsistent bedtime, and 24 (26.7%) did not sleep the same amount each day. Twenty-nine (32.2%) and 18 (20.0%) children had an internalizing and externalizing problem in clinical range, respectively. Sleep anxiety was significantly (p < .01) associated with increased internalizing and externalizing problems, even after the relevant epilepsy variables were controlled for. Findings from our study suggest that screening of sleep and behavior problems should be part of routine epilepsy care to identify children with problematic sleep and unrecognized sleep disorders and those at risk of behavioral dysfunction.

Adequate physical activity is associated with improved sleep in adults. Such associations, however, vary greatly across studies in pediatric populations, with no studies involving infants found in the literature. This prospective observational study was designed, therefore, to examine the association between physical activity and sleep patterns in infants. A total of 183 healthy infants aged 6 months wore an actigraph for 7 days to measure physical activity and sleep. Parents and caregivers completed a sleep-activity diary over the same period documenting the different types of infant activities. Daily mean time spent in screen-time-or-limited physical activity, including screen-based (e.g., watching television or other electronic devices) and non-screen based activity (e.g., quiet play or restricted infant movement when carried by caregivers or seated in high chairs, swings, or bouncer seats), was 6.68 hr (SD = 1.99), which represented 47.50% of daytime waking hours (SD = 13.73). We found that 65 (35.5%) infants engaged in some screen time during the study, with 10 (5.5%) infants having an average daily screen time >30 min. In our multivariate linear regression model, more hours of screen-time-or-limited physical activity per day were significantly associated with a decrease in total daily 24 hr sleep duration (p < 0.01). Findings from our study suggest that reducing screen-time-or-limited physical activity might be an approach for promoting adequate sleep and lengthening infant daily sleep duration.

To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings.Cross-sectional study.Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends.Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent.Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary.Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.

Background Anger is considered a common method used by patients to relieve emotional frustrations. However, this emotional response is not a common research focus for adolescents with cancer. Objective The aim of this study was to determine whether self-concept mediated the relationship between anger and resilience for adolescent patients currently being treated for cancer. Methods A cross-sectional study of 40 adolescents with cancer was conducted. The instruments included the Chinese Beck Self-Concept Inventory, the Chinese Beck Anger Inventory, and the Chinese Resilience Scale. Mediation analysis was also conducted. Results The results indicate that (1) variations in anger significantly account for 6.86% of observed variations in self-concept, (2) variations in self-concept significantly account for 52.83% of observed variations in resilience, (3) variations in anger significantly account for 10.96% of observed variations in resilience, and (4) when paths in conditions 1 and 2 were controlled, variations in anger through self-concept significantly account for 54.04% of observed variations in resilience, and variations in anger did not significantly account for observed variations in resilience. Conclusions Gender and age might affect anger control. Despite worse physical functioning and an impacted appearance, participants had normative-to-positive self-concept levels, suggesting that their self-concept might not be affected by cancer. Self-concept might play a mediating role between anger and resilience, thus helping to bridge this knowledge gap. Implications for practice The current gap in knowledge regarding the mediating relationship necessitates the implementation of a large-scale study designed to verify the mediating role of self-concept between anger and resilience.

Background Fatigue is among the most prevalent and distressing symptoms in pregnant and postpartum women. Estimating fatigue severity with a psychometrically sound instrument provides the most fundamental information for understanding women's fatigue experience and assessing the need for intervention to improve maternal and infant health outcomes. Objectives To evaluate the psychometric properties of a Chinese version of the 7-item Lee Fatigue Scale-Short Form (C-LFS-SF) in pregnant and postpartum women. Methods The study was composed of two phases: translation of the scale into Chinese and examination of content validity, and testing to establish the reliability and validity. A convenience sample of 124 women completed health-related questionnaires, kept a fatigue diary and wore a wrist actigraph for 7 days during the third trimester of pregnancy and within three months postpartum. Results The C-LFS-SF showed satisfactory internal consistency (Cronbach's alpha≥.97) and stability over the 7 days at each time point (intraclass correlation coefficient>.87). Exploratory factor analysis showed that 88–94% of the total variance was explained by the one-factor fatigue model. Significant associations among the C-LFS-SF and actigraphic sleep quantity and quality variables supported adequate construct validity. Conclusions The C-LFS-SF has satisfactory psychometric properties and is an easy and promising tool for assessing maternal fatigue during routine prenatal and postpartum care. This scale needs to be further tested in a more diverse population of pregnant and postpartum women, like women with high risk pregnancies or with medical conditions.

We prospectively examined the associations of nighttime and daytime sleep during the third trimester of pregnancy with labor duration and risk of cesarean deliveries in a convenience sample of 120 nulliparous women who completed sleep-related questionnaires and wore wrist actigraphs for up to 7 days. Nap duration and 24-hour sleep duration were inversely associated with labor duration in women with vaginal delivery. Neither actigraphy-derived nor self-reported sleep variables were associated with type of delivery (e.g., vaginal, cesarean). Results showed a beneficial effect of sleep on labor duration and suggest that studies of sleep duration effects on labor and pregnancy outcomes require a consideration of the amount of both daytime and nighttime sleep.

We evaluated the psychometric properties of a Mandarin Chinese version of the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) in pregnant women. A total of 228 first-trimester pregnant women participated in the study, which was conducted in an outpatient obstetric clinic at a medical center in Taipei, Taiwan. The Chinese version of the FOSQ-10 demonstrated satisfactory internal consistency (Cronbach alpha = .85), adequate corrected item-total correlations (from .40 to .67), and acceptable test-retest reliability over 7 days (ICC = .73). Construct validity was supported by exploratory factor analysis showing a one-factor structure with item loadings between .49 and .77. Significant associations with the Medical Outcomes Study Short-Form Health Survey 12 version 2 and Pittsburgh Sleep Quality Index supported criterion-related and convergent validity. Significant differences in the Chinese version of the FOSQ-10 total scores were found between women with clinically significant daytime sleepiness and those without, suggesting adequate discriminant validity. Ceiling effects were observed for all items, but no floor or ceiling effects were found for total scores. Findings suggest that the Chinese version of the FOSQ-10 is a valid and reliable instrument to identify important effects of sleep-related impairment in Chinese women during pregnancy. Further testing is needed in more diverse pregnant women, such as women with complicated pregnancies and those with sleep disorders. © 2016 Wiley Periodicals, Inc.

BACKGROUND: Physical activity (PA) is a significant predictor of health outcomes in children with and without chronic conditions. Few researchers have used actigraphy as an objective measure of PA during the child's normal daily routines, and the findings have been inconsistent. It is unclear if asthma can contribute to low PA levels. OBJECTIVES: The aim of this study was to compare daytime PA levels in children with and without asthma and examine the relationships among asthma, PA, body mass index (BMI), and child reports of symptoms. METHODS: Physical activity as measured by actigraphy and self-report symptoms of coughing, wheezing, chest tightness, perceived tiredness, sleepiness, and alertness were obtained in 54 children aged 9-11 years with and without asthma for 7 consecutive days. Activity variables derived from actigraphy included (a) mean daytime activity level; (b) peak daytime activity level; and (c) time duration spent in sedentary, light, moderate, vigorous, and total moderate plus vigorous PA (MVPA). RESULTS: Children with and without asthma did not differ on BMI or activity levels. Children with asthma reported more activity limitations due to breathing problems than children without asthma (p < .01). In multivariate analyses, asthma predicted reduced mean, peak, and total time spent in MVPA level after controlling for gender, BMI, and self-report of symptoms. A significant interaction was found between asthma and BMI on mean, peak, and total time spent in MVPA. DISCUSSION: The association between asthma and PA is complex when the child's BMI is considered. Results suggest that reduced PAs with respect to respiratory symptom severity, childhood obesity, and functional impairment are important areas for future studies.

In this pilot study we examined the relationship between objective and subjective sleep disturbances and depressive symptoms in 22 healthy primiparous postpartum women within 3 months after delivery. We found that none of the women in our study had clinically significant depression scores on the Edinburgh Postnatal Depression Scale; nonetheless, a variable duration of night-time sleep from night to night during the 7-day monitoring period and reported awakening too early were significantly correlated with increased depressive symptoms. Results suggest that first-time mothers who complain of irregular night-time sleep duration and waking up too early should be screened and evaluated for potential postpartum depressive symptoms.

OBJECTIVES To examine the association among nighttime sleep and daytime napping behaviors, depressive symptoms, and perception of fatigue in pregnant women. DESIGN A prospective descriptive study with within-subject design. SETTING A university-affiliated hospital and participants' home environments. PARTICIPANTS Thirty-eight third trimester nulliparous women completed sleep and depressive symptom questionnaires, wore a wrist actigraphy monitor for 7 consecutive days, and kept a concurrent diary reporting naps and rating their level of fatigue using a 0-10 visual analogue scale each morning, midday, afternoon, and evening. A generalized estimating equation regression model was applied to evaluate the time-dependent association. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Mean duration of total nighttime sleep by actigraphy was 386.3 ± 60.7 min, with 11 (28.9%) women having an average total nighttime sleep 3 days, and only 2 women did not nap over the entire week. Antecedent night sleep duration had a significant inverse association with morning (P = 0.022) and afternoon fatigue (P = 0.009) of the subsequent day. Self-reported naps were significantly associated with midday fatigue (P = 0.003). More depressive symptoms predicted more severe fatigue throughout the day. CONCLUSIONS Results suggest that interventions designed to increase sleep duration and decrease depressive symptoms have the potential to prevent, ameliorate, or reduce fatigue in pregnant women. Depressive symptoms during pregnancy likely share some psychological and behavioral tendencies with fatigue and/or sleep disturbance which may complicate the evaluation of intervention effect.

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 score5) 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.

Background Sleep disturbance, depression, and daytime sleepiness are among the most prevalent symptoms reported by women during pregnancy. However, available data on the association between sleep disturbances and symptoms of depression and daytime sleepiness in pregnant women are sparse and methodological limitations have been acknowledged. The purpose of the study was to examine objective and self-reported sleep disturbances and symptoms of depression and daytime sleepiness in a group of healthy pregnant women. Methods A total of 274 third-trimester pregnant women wore a wrist actigraph continuously for 7 days to assess objective sleep quality and quantity. Self-reported sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), with self-reported poor sleep quality defined as a PSQI score more than 5. The Center for Epidemiologic Studies-Depression Scale (CES-D) and Epworth Sleepiness Scale were used to evaluate symptoms of depression and daytime sleepiness, respectively. Results Sixty-four (23.4%) women were at risk for clinical depression and 69 (25.2%) had daytime sleepiness. Risk of clinically meaningful depressive symptomatology was significantly increased in women with objective total nighttime sleep less than 6 hours (OR 2.53 [95% CI 1.26–5.08]) and self-reported poor sleep quality (OR 3.31 [95% CI 1.74–6.30]), even after multiple adjustment. Neither objective nor self-reported sleep disturbances increased daytime sleepiness in this group of pregnant women. Discussion Both objective nighttime sleep less than 6 hours and self-reported poor sleep quality in healthy third-trimester pregnant women is associated with significant risks for clinical depression. Improving sleep would likely be associated with a reduction in depression symptom severity and an attenuation of the prevalence of depression in pregnant women.

tsai s.-y., thomas k.a., lentz m.j. & barnard k.e. (2011) Light is beneficial for infant circadian entrainment: an actigraphic study. Journal of Advanced Nursing68(6), 1738–1747. Abstract Aim. This article is a report of an exploratory study of the relation between light exposure and circadian rest–activity patterns in infants. Background. Ambient light is a major environmental stimulus for regulation of circadian rhythm of sleep and wake in adults, but few studies have been conducted to examine environmental light exposure in relation to rest–activity circadian rhythm parameters of infants. Methods. An intensive within-subject design was used with a convenience sample of 22 infants (mean postnatal age 49·8 days) who wore a combined light and activity monitoring device for seven consecutive days at home. For each infant, light data (lux) were aggregated over the 7 days into categories of illumination and expressed in mean minutes/day. Circadian light and activity parameters, including mesor, amplitude, acrophase and R2 cosinor fit, were determined using cosinor analysis. Associations between light exposure and circadian rest–activity rhythm parameters were examined using correlation and regression analyses. Data were collected between 2006 and 2007. Results. Infants spent only one-eighth of their daytime hours in an environment with >100 lux light level. There was a relatively large statistically significant relation between the acrophase of light exposure and the acrophase of activity. Increased duration of daily exposure to >100 lux of illumination, and increased amplitude of circadian rhythm of light were associated with stronger circadian patterns of infant activity. Conclusion. Results suggest an association between light and activity patterns and that increasing duration of exposure to moderate light levels may be a simple and economical nursing intervention during the early postnatal weeks.

BACKGROUND : Sleep disturbance is a significant health issue in pregnant women. Although previous studies contribute to an understanding of the multifactorial nature of pregnancy-related sleep disturbance, objective measures of sleep were not included, and so data may be subject to recall and potential participant self-report bias. OBJECTIVE : The aim of this study was to identify sociodemographic, lifestyle, and health-related factors associated with poor sleep quality in women during their third trimester of pregnancy. METHODS : This prospective study included 30 nulliparous women who wore a wrist actigraph to objectively monitor sleep for 7 consecutive days and completed the Pittsburgh Sleep Quality Index. RESULTS : Fifteen women (50%) had a Pittsburgh Sleep Quality Index global score of >5, indicating poor sleep quality. Mean actigraphic sleep efficiency was only 80.05% ± 6.27%. There were significant differences (p < .01) in sleep offset time and total nocturnal sleep time between weekdays and weekends. Later sleep onset time was associated with poorer sleep, including longer sleep latency, and reduced total nocturnal sleep time and sleep efficiency. DISCUSSION : Nulliparous women experience both objective and subjective sleep disturbances, and their sleep patterns differ between weekdays and weekends during their third trimester of pregnancy. Results suggest that maternal sleep pattern may be improved by maintaining a regular and earlier bedtime so women have more opportunity to obtain sufficient nocturnal sleep and improved sleep quality.

Isolated oculomotor nerve palsy after mild head injury is rare. Only a few case reports have described the clinical presentation of these patients, and clinical and functional outcome have not been discussed in depth. The outcome of 10 patients with mild head injury in whom imaging studies ruled out other possible causes of oculomotor palsy was assessed during follow-up using the Glasgow Outcome Scale–Extended (GOSE). We suggest that limited eye movement is a major factor that negatively affects functional status after mild head injury.

Introduction Asthma control requires assessment of nighttime symptoms and sleep disruption. Cognitive and emotional development enables most school-aged children to report nocturnal problems, but providers often rely only on parental report, potentially limiting the comprehensiveness of their assessments and their ability to support the child's emerging efforts at shared management of their illness. This study investigated parent-child concordance in report of nighttime respiratory symptoms, sleep disruption, and quality of sleep in a sample of 9- to 11-year-old children with asthma. Secondarily, similar concordance patterns in an equal number of dyads where the child was asthma free were examined to illustrate the potential influence of asthma. Method Parents and children completed 1-week diaries in their homes without confiding in one another. The probability of knowing the child's report on a specific item if the parent's report was known was assessed using contingency tables. Results Within the asthma group, parent-child reports differed significantly across all symptoms and sleep parameters. Parents most often reported fewer symptoms and awakenings and better quality of sleep than did their child. Concordance rates were lowest for morning perceptions of tiredness, sleepiness, and alertness in both asthma and non-asthma groups. Discussion Both parents and school-aged children with asthma need to be asked about nighttime asthma symptoms, sleep, and morning perceptions when attempting to evaluate asthma control. Assessment of sleep in all children should include parent and child reports and would benefit by the addition of objective measures.

Background Adequate light exposure is critical for entraining circadian rhythms, regulating sleep–wake cycles, and maintaining optimal mood. Yet, few studies have reported normative data on light exposure experiences in postpartum women and young infants; none has examined the two simultaneously. Objectives The objective of this pilot study was to document the 24-h light exposure experiences in postpartum women and their infants. Design An intensive within-subject design was employed. Settings The participant's natural home environment. Participants Twenty-four healthy mother–infant pairs were recruited from the general community in Seattle, USA. Two mother–infant pairs did not have complete data, resulting in a final sample size of 22 (12 female infants). Methods Mothers and infants wore a monitor to continuously record illumination levels for 7 days. Data were aggregated within subject to calculate summary measures of illumination exposure. Circadian patterns of light were examined using cosinor analysis. Pearson correlation was used to examine the relation between maternal and infant light exposure. Results Mothers spent 71.13±11.58% and infants spent 80.07±8.27% of their daytime hours (defined as 06:00–21:59) in an illumination level 1000lux per day was 54±39 for mothers and 23±18 for infants. Maternal and infant light exposure exhibited a modest circadian pattern and a strong correlation, both in the timing of peak illumination exposure ( r =0.93, p r =0.70±0.07). Conclusions Postpartum women and infants experience low ambient light levels with short periods of bright light during the day. Whether this level of light is sufficient for optimal postpartum mood and infant circadian entrainment warrants further investigation. If higher levels of light were indeed necessary for postpartum women and young infants, increasing ambient light levels through the use of natural sunlight (i.e., walking outdoors) could be a simple and economic nursing intervention. The strong pattern synchrony between maternal and infant light exposure suggests that mothers play the primary role in providing a lighting environment suitable for infants to synchronize their circadian rhythms to a 24-h day.

This research examines subjective and objective report of naps and nighttime sleep in 9- to 11-year-old children with and without asthma.This between subjects study collected prospective self-report diary and objective actigraphy measures of sleep from 27 children with and 27 without asthma during a 7-day/6-night at-home monitoring period.Thirty-two percent of participants reported daytime naps. Nappers were more likely to be children with asthma (12/27 vs. 5/27, p = 0.04) even though the children with asthma did not report being more tired, sleepy, or less alert in the morning. Nappers did not differ from non-nappers on self-report measures of overall sleep quality or number of awakenings but were documented, via objective measures, to have later (clock time: 23:05 vs. 22:21, p = 0.04) and more variable (Levine's Test for Equality of Variances: F = 10.68, p = 0.002) sleep onset times than non-nappers. Sleep offset times did not differ between the nappers vs. non-nappers, therefore, nappers had fewer total minutes of nighttime sleep than did the non-nappers (437 vs. 465, p = 0.04). Later (clock time: 23:01 vs. 22:15, p = 0.01) sleep onset times were also documented in minority vs. Caucasian children.Napping appears a more common behavior than expected especially in children with asthma or of minority ethnicity but the reasons are unclear. Self-report measures may not capture important sleep characteristics that objective measures can identify. Strategies to reduce late and variable bedtimes of all children are needed given our awareness of the negative cognitive, emotional, and behavioral consequences of poor sleep in children.

Purpose:To describe the effect of nursing caregiving on infant sleep-wake states by gender in preterm infantsDesign:Descriptive measures at 34 weeks postmenstrual age and at dischargeSample:Twenty-two hospitalized preterm infantsMain Outcome Variable:Infant state and caregiving episodes were coded in 15-second intervals from video recordings of approximately three hours duration. Time plots of state and caregiving were analyzed visually to summarize spontaneous state changes and state change associated with caregiving.Results:Sleep and wake state distribution did not differ statistically by gender; however, the rate of state change in male infants was twice that of females (p=.012) at discharge. At discharge, male infants received approximately twice as many care episodes as females. At discharge, the rate of state change in response to caregiving in male infants was four times that of female infants (p=.026). Males exhibited a greater percentage of caregiving episodes related to state change than did females at discharge (p=.018). Findings suggest further exploration of possible gender differences in state regulation and state change in response to caregiving.

OBJECTIVES A descriptive pilot study to examine sleep and daytime naps in adolescent girls with chronic musculoskeletal (MSK) pain. METHODS Seventeen girls (14.9 +/- 2.0 years) completed questionnaires on anxiety and depressive symptoms during their clinic visit, and maintained a sleep diary and wore an actigraph for 7 days. Parents completed a daily diary of their teen's medications and approaches used to ease pain. RESULTS Average nighttime sleep was 7.2 hr by actigraphy. All participants had mean sleep efficiency

Sleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy.To examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women.A prospective observational study.A university-affiliated hospital in Taiwan and participants' homes.A total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester.Objective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life.Sixty-four (39.0%) women consistently had an average sleep efficiency85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep (p=0.04) and better subjective sleep quality (p0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency (p=0.04) and better subjective sleep quality (p0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep (p0.01) and better subjective sleep quality (p0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep (p0.05) and subjective sleep quality (p0.01) predicted mental health-related quality of life in the second and third trimester.Sleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy.

Understanding how cancer symptom distress and resilience contribute to quality of life (QoL) in adolescent cancer and may potentially help these patients achieve better health-related outcomes. The objective of this study was to describe cancer symptom distress, QoL, and resilience in adolescents with cancer and to determine whether resilience is a mediating variable. Forty adolescent cancer patients were recruited, and data were collected via a demographic questionnaire, the Cancer Symptom Distress Scale, the Resilience Scale, and the Minneapolis-Manchester Quality of Life Scale. Pearson’s correlation, multiple regressions, and the Sobel test were conducted. Both resilience and cancer symptom distress were regressed against QoL, accounting for 62.1% of observed variation in QoL scores. The bootstrap result estimated the true indirect effect between −.0189 and −.0024, with a 95% confidence interval. Resilience mediates the relationship between cancer symptom distress and QoL. Clinical use of a resilience measure, for example to use in developing and evaluating interventions focused on enhancing resilience, may be practical for nurses.

Background. Lack of education is a known barrier to vaccination, but data on the design and effectiveness of interventions remain limited. Objective. This study aims to identify the effectiveness of a Facebook-assisted teaching method on female adolescents’ knowledge and attitudes about cervical cancer prevention and on their human papillomavirus vaccination intention. Method. A quasi-experimental time series research design was used. Two hundred female adolescents at a senior high school in Taipei were recruited into two groups. Following a classroom lecture, one group was provided a Facebook-assisted online discussion, and the other group was provided an in-person discussion forum. A demographic questionnaire and cervical cancer prevention questionnaire were distributed. Data were analyzed for descriptive statistics and generalized estimation equations. Results. Improvement from T0 to T2 in knowledge and attitude scores was 4.204 and 4.496 points, respectively. The Facebook group’s improvement in vaccination intention from T0 to T2 was 2.310 times greater than the control group’s improvement under conditions of out-of-pocket expenses and 2.368 times greater under conditions of free vaccination. Conclusions. School-based cervical cancer prevention education can be effective. The Facebook-assisted discussion method was more effective than the in-person discussion. Providing the human papillomavirus vaccine free of charge would increase female adolescents’ intention to be vaccinated.