Search

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.

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.

Objective to describe the aspects of infant sleep perceived as problematic by first-time Taiwanese mothers and to discover how mothers cope in response to infant sleep concerns. Design a qualitative approach was used for data collection. Setting in-depth interviews were conducted and audio-taped at mothers' homes. Participants 12 first-time mothers within three months post partum. Measurement and findings content analysis was performed to identify patterns, similarities, and differences in the individual and collective interview data. The major themes describing maternal coping experiences were ‘self-help' and ‘seek-help.' Self-help coping efforts included reception and acceptance of suggestions as well as changing behaviour to allow mothers to feel capable of adapting to infant sleep patterns or problems. Seek-help was a later stage of coping for mothers when they actively utilised formal and informal sources of help to identify and manage infant sleep problems. The majority of mothers sought informal help sources from family members, friends, or online information. Mothers who suspected their infant of suffering from sleep problems either delayed seeking medical advice or did not actively consult a health care provider. Conclusions and implications for practice nurses and health care providers who work in antenatal, postnatal, and paediatric clinics should actively educate and provide information about infant sleep patterns and sleep management options to first-time mothers and discuss maternal coping strategies.

Napping is highly prevalent in pregnant women, but the relation between nighttime sleep and daytime naps in pregnant women is poorly understood.The aim of this study was to examine the temporal association of nighttime sleep quality and quantity with subsequent daytime naps and the temporal association of daytime naps with sleep quality and quantity the following night in women during the third trimester of pregnancy in Taiwan.Sleep was assessed in 80 Taiwanese nulliparous women aged 31.70 years (SD = 4.58 years) using actigraphy and diaries for 7 consecutive days. Subjective sleep quality was examined using the Pittsburgh Sleep Quality Index. Multiple linear regressions with generalized estimating equations were used to examine the temporal associations of nighttime sleep and daytime naps.All women napped sometime during the study week, and mean Pittsburgh Sleep Quality Index global score was 6.6, indicating poor sleep quality. Fewer weekly work hours and shorter sleep duration the preceding night were associated with longer nap duration the next day. More work hours, longer nap duration, and more intense fatigue were associated with shorter sleep duration the following night.Naps during pregnancy might indicate insufficient nighttime sleep, and longer daytime naps could compromise subsequent nighttime sleep. Further research is needed to determine if short sleep duration and longer daytime naps are associated with negative pregnancy outcomes.

The aim of the present study was to identify genetic and epigenetic alterations involved in the progression of oligodendroglial tumors. We characterized 21 paired, World Health Organization (WHO) grade II and III oligodendroglial tumors from patients who received craniotomies for the partial or complete resection of primary and secondary oligodendroglial tumors. Tumor DNA was analyzed for alterations in selected genetic loci (1p36, 9p22, 10q23–24, 17p13, 19q13, 22q12), isocitrate dehydrogenase 1 (IDH1), isocitrate dehydrogenase 2 (IDH2) and the CpG island methylation status of critical tumor-related genes (MGMT, P16, DAPK, PTEN, RASSF1A, Rb1). Alterations of these markers were common early in the tumorigenesis. In the primary tumors we identified 12 patients (57.1%) with 1p36 deletions, 17 (81.0%) with 19q13 deletions, 9 (42.9%) with 1p36/19q13 codeletions, 11 (52.3%) with 9p22 deletions, and 12 (57.1%) with IDH1 mutation. Epigenetic analysis detected promoter methylation of the MGMT, P16, DAPK, PTEN, RASSF1A, and Rb1 genes in 38.1%, 19.0%, 38.1%, 33.3%, 66.7%, and 14.3% of primary tumors, respectively. After progression, additional losses of 1p, 9p, 10q, 17p, 19q and 22q were observed in 3 (14.3%), 1 (4.8%), 3 (14.3%), 2 (9.5%), 1 (4.8%) and 3 (14.3%) cases, respectively. Additional methylations of the MGMT, P16, DAPK, PTEN, RASSF1A, and RB1 promoters was observed in 4 (19.0%), 2 (9.5%), 0 (0%), 6 (28.6%), 2(9.5%) and 3 (14.3%) cases, respectively. The status of IDH1 mutation remained unchanged in all tumors after progression. The primary tumors of three patients with subsequent progression to high-grade astrocytomas, all had 9p deletion, intact 1p, intact 10q and unmethylated MGMT. Whether this may represent a molecular signature of patients at-risk for the development of aggressive astrocytomas needs further investigation.

Infant sleep is a challenge among parents and a problem seen frequently in pediatric practice. Actigraphy, an activity-based sleep monitoring system, uses a wristwatch-like device with an accelerometer sensitive to body movements. Activity counts derived from actigraphy serve as the basis for sleep-wake determination. Although it has been concluded that actigraphy is a valid measure of sleep during infancy,1,2 external motion, a common experience for infants (eg, being carried or put in an infant swing), is usually overlooked in studies that use actigraphy to assess infant sleep. In some studies, actigraphy records containing external motion were removed prior to analysis2,3; in others, data involving external motion were included,4,5 with most studies not specifying how such data were analyzed. The objective of this study was to assess the activity count and sleep-wake identification accuracy by actigraphy when an infant doll was exposed to external motion.

Following sciatic nerve transection in adult rats, a proportion of injured dorsal root ganglion (DRG) neurons die, through apoptosis, over the following 6 months. Previous studies showed that axotomy and neurotrophin-3 administration may have effects on expression of neurotrophins and their receptors in DRG. In the current study, the fourth and fifth lumbar DRGs of rats were examined 2 weeks after right sciatic nerve transection and ligation. The effects of axotomy and systemic NT-3 treatment on neuronal genes were investigated by microarray. The results demonstrated that bone morphogenetic protein (BMP) and Janus protein tyrosine kinase signaling pathways are induced in axotomized DRG, and PI-3 kinase and BMP pathways and genes controlling various cellular functions were induced after axotomy and NT-3 administration.

Objective: Entrainment to the day—night cycle is critical for infant sleep and social development. Synchronization of infant circadian systems with the social 24-hr day may require maternal activity signals as an entraining cue. This descriptive and exploratory research examines the activity level and circadian pattern in mothers and infants. Method: Twenty-two healthy mothers and their infants (postnatal age 49.8 ± 17.1 days) wore actigraph monitors for seven days. Daytime (06:00—21:59) and nighttime (22:00—05:59) activity levels and circadian parameters of rest—activity patterns (i.e., mesor, amplitude, acrophase, and 24-hr cosinor fit) were calculated. Results: Mothers and infants were significantly more active during the day than at night. The goodness-of-fit index for the model (R2) indicates that circadian rhythm accounted for a mean of 29 ± 10% and 12 ± 8% of the variability in maternal and infant activity, respectively. Acrophase of activity occurred at 15:46 ± 1:07 for the mothers and 15:20 ± 1:21 for the infants. The mean within-dyad correlation of activity counts was r = .46 ± .11, and the within-dyad correlation was associated with the amplitude (r = .66, p < .01) and 24-hr cosinor fit of infant activity (r = .67, p < .01). Conclusions: Our findings suggest maternal rhythms as a possible exogenous influence on shaping an infant’s emerging rhythms and synchronizing them with the external light—dark cycle. Strong pattern synchrony between maternal and infant activity may support infant circadian entrainment and enhance a regular 24-hr sleep—wake schedule during the early postnatal weeks.

Correspondence between infant actigraphy and mother-recorded diary differed significantly when receiver-operator function area under the curve, correlation, and logistic regression were calculated with and without excluding periods of external motion. External motion occurred in 40% of recording time and significantly changed activity count per epoch.

A descriptive pilot study to examine sleep and daytime naps in adolescent girls with chronic musculoskeletal (MSK) pain.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.Average nighttime sleep was 7.2 hr by actigraphy. All participants had mean sleep efficiency90%. In diaries, 76.5% of the girls reported daytime naps; five girls reported more than three days with naps and more naps were associated with lower sleep efficiency and total nighttime sleep.Adolescent girls with chronic MSK pain may sleep fewer hours at night than is recommended and nap in the daytime to compensate for insufficient nighttime sleep.

SummaryExtracranial and meningeal seeding of glioblastoma multiforme is rare. We report herein a case of glioblastoma in a 41-year-old man who underwent surgical resection, concomitant chemoradiotherapy (CCRT) and seven courses of adjuvant chemotherapy with temozolomide. The patient then complained of intermittent severe lower back pain and gait disturbance. Imaging studies demonstrated that although the intracranial residual tumors were well-controlled by the treatment, meningeal seeding involving the brainstem and spinal cord was present. The patient died 2 months after the diagnosis of spinal seeding. This case illustrates the need for consideration of extracranial metastasis if a patient is symptomatic, even if the intracranial tumor appears responsive to treatment. We suggested that the prophylactic craniospinal irradiation may be considered in patients at high risk of meningeal seeding immediately after surgery.