Evaluating a family-centred intervention for infant sleep problems

AIM: This paper reports a study to describe changes in parents' distress after a family-centred intervention for sleep problems of infants. BACKGROUND: Infant sleep problems are common and are related to depressive symptoms in mothers, but their impact on fathers has rarely been studied. Because childhood sleep problems and parental distress are associated, their interdependence should be recognized in research and in paediatric sleep practice. METHODS: All children hospitalized for sleep problems in a hospital in Iceland in 1997-1998 and their parents were studied using a pre- and post-test quasi-experimental design. The sample consisted of 33 infants (6-23 months of age), 33 mothers and 30 fathers. Parents' distress was assessed before and after treatment with regard to: (1) fatigue and resulting symptom distress; (2) parenting stress; (3) state-anxiety; and (4) depressive symptoms. Infants were treated for a variety of sleep problems by a paediatric nurse. The parents were simultaneously treated for distress by either the paediatric nurse or a specialist, depending on the nature of their problems. RESULTS: Mothers and fathers experienced a high degree of distress before the intervention, with no significant difference between them. Two months after the intervention both parents' distress had significantly improved. Parents' degree of distress was at a psychopathological level before the intervention but was reduced to population norms 2 months after the intervention. The paediatric nurse intervention was sufficient to reduce distress for 83% of parents. CONCLUSIONS: Health care professionals who care for infants with sleep problems should pay attention to the distressed responses of parents and support their recovery. An intervention such as that described here could be used by nurses for this purpose.     

Effects on parents of an intervention to resolve infant behavioral sleep problems

PURPOSE: Because behavioral sleep problems affect a large proportion of infants and can result in health issues for children and their parents, the study evaluated the effects of a sleep intervention for infants from 6 to 12 months old. METHOD: For this quasi-experimental one group pre-test and post-test design, 39 eligible families were recruited through a newborn hotline. Seventy parents with healthy 6 to 12-month old infants completed the intervention. The intervention involved information about infant sleep and strategies for sleep problems in classes of up to 6 couples, chart completion, and bi-weekly telephone calls for 2 weeks. The primary outcome measures were parents' sleep quality, fatigue, cognitions about infant sleep, depression, marital harmony, and sleepiness. FINDINGS: Following the intervention, there was a significant improvement in parents' sleep quality, cognitions about infant sleep, fatigue, and depressed mood. CONCLUSIONS: The study findings demonstrated that providing parents with information and support to assist with infant behavioral sleep problems can improve parental psychological well being.     

Occupational therapy in early intervention: a family-centered approach

This article describes a framework for occupational therapy service provision in early intervention settings and presents pilot data aimed at examining the framework's effectiveness. The Family-Centered Framework for Early Intervention is a synthesis of concepts from the Model of Human Occupation (Kielhofner & Burke, 1980) and from the literature on play. It encompasses a systematic, holistic approach that considers the child and the family within the context of their life environments. In this framework, play is used both as an evaluative tool and as an intervention modality that addresses the volition, habituation, and performance of the child and family as well as the strengths and weaknesses of the environment. Play is also used as a primary measure of competence and change. This framework may be useful in defining occupational therapy roles for the early intervention population.     

抚触干预婴儿睡眠障碍的研究

目的探讨抚触与婴儿睡眠相关关系。方法对 10 0例健康新生儿做睡眠状态调查 ,平均每日睡眠时间为 17± 1.5h。将每日睡眠时间 <17h的 12 4例新生儿随机分为抚触组和对照组。对照组不做任何干预 ,抚触组每天用国际标准法抚触 2次 ,每次 15～ 2 0min。持续 3个月以上。观察 4 2d、3个月、6个月婴儿睡眠状态。结果抚触组 4 2d、3个月平均每日睡眠总时间多于对照组。 4 2d、3个月、6个月夜醒次数及时间、啼哭次数及时间少于对照组。睡眠障碍发生率及程度比对照组低而轻。建立规律睡眠时间早于对照组 ,两组差异有显著性意义 (P <0 .0 5 )。结论抚触有助于提高婴儿睡眠质量 ,减少睡眠障碍发生率 ,并能较早地建立规律睡眠时间 ,有利于婴儿的生长发育。     

Practical non-pharmacological intervention approaches for sleep problems among older adults

Poor sleep is common among older adults, often caused by multiple underlying factors such as chronic stress. Poor sleep is subsequently associated with negative health outcomes including higher morbidity and mortality. Our primary purpose is to explore practical non-pharmacological intervention approaches integrating stress management to improve sleep quality among older adults. In doing so, we highlight approaches that appear to hold promise in real-world settings with older individuals. We conducted a tailored literature review specifically on approaches to improve sleep quality among older adults, with emphasis on those integrating stress management. Online search engines were reviewed to identify research in these areas. Various non-pharmacological intervention approaches, such as mindfulness and cognitive behavioral therapy, have shown promise in improving sleep quality and health outcomes within this population. Those integrating chronic stress management appear to be particularly successful. Thus further development of multidimensional sleep interventions integrating stress management with seniors is warranted.     

以家庭为中心的护理干预在小儿支气管肺炎中的应用

目的：探讨以家庭为中心的护理干预在小儿支气管肺炎患儿中应用效果。方法将104例支气管肺炎患儿随机分为观察组和对照组,各52例。对照组采取常规干预措施,观察组在常规措施的基础上进行以家庭为中心的护理干预措施,对疗效和肺功能恢复情况进行对比分析。结果护理干预后观察组治愈19例,显效20例,有效9例,无效4例,有效率为92．3％,对照组治愈13例,显效9例,有效16例,无效14例,有效率为73．1％,两组治疗有效率比较差异有统计学意义（χ2＝19．549,P＜0．01）;观察组患者在咳嗽消失时间、停止咯痰时间、平喘时间、退热时间及肺部啰音消失时间分别为（9．78±2．07）,（7．28±1．76）,（4．32±1．13）,（4．02±1．17）,（7．84±1．14）d,均低于对照组,差异有统计学意义（t值分别为5．009,7．489,3．632,9．512,5．915;P＜0．05）。结论小儿支气管肺炎患儿采用以家庭为中心的护理干预,对提高其临床疗效,促进肺功能恢复具有重要意义,值得大力研究与推广。     

护理干预对心脏介入术后患者睡眠质量的影响

目的 探讨护理干预对心脏介入术后患者睡眠质量的影响.方法 选取我院2010年1月至2011年1月收治的140例行心脏介入手术的患者作为研究对象,按照随机分组的原则将其分为观察组与对照组各70例,对照组患者采用常规心内科护理方法进行护理,观察组患者在对照组常规护理的基础上再予以与睡眠相关的护理干预措施,比较2组患者术后24h及术后1,2周的睡眠质量评分(PSQI)及术后2周的治疗依从性.结果 2组患者术后24 h的PSQI评分无明显差异,但1,2周后的PSQI评分比较,观察组均明显低于对照组;术后2周的治疗依从性比较,观察组患者完全依从率明显高于对照组患者,不完全依从率明显低于对照组.结论 采取护理干预可以有效提高患者的治疗依从性,改善心脏介入术后患者的睡眠质量,利于患者疾病的康复,值得临床推广应用.     

The Weighty Matter intervention: a family-centered way to tackle an overweight childhood

The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed "The Weighty Matter" intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n=86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.     

Changes in sleep problems, parents distress and impact of sleep problems from infancy to preschool age for referred and unreferred children

This article compares and describes changes in sleep problems in 3- to 5-year-old Icelandic children referred and unreferred for sleep problems in infancy and explores changes in parents' distress and the impact of children's sleep problems on families over time. The sample consisted of a clinical group (n = 31) that had been referred to a sleep-disorder clinic in infancy, and a comparative group (n = 150) of age-matched unreferred community children. Self-report scales assessed infant/child sleep pattern, the impact of the sleep problem on family life and parents' distress. Results showed that about half the children in the community group have had a sleep problem in infancy. Nightwakings improved in both the referred and unreferred group over time but remained more frequent in the unreferred group. The referred group had significantly more settling problems in infancy than the other group but settling improved markedly over time. Parents of referred children were more fatigued compared with others despite improvement of children's sleep problems over time. Mothers of referred children were however, less likely to perceive the sleep problem as troublesome for family life than the others. It is concluded that parents of referred children are more fatigued than parents of unreferred children and nightwakings are more likely to persist in children who had sleep problems in infancy than in those with no such problems.     

冠状动脉支架置入后相关炎症因子的变化及其干预

背景:冠状动脉粥样硬化性心脏病支架置入治疗后的炎症反应以及其严重程度与再狭窄明显存在相关性,医学工作者试图从中寻找新思路预防支架置入后再狭窄,提高治疗质量.目的:评价各种干预措施以及监测手段在冠状动脉置入术后炎症治疗中的应用价值和临床前景.方法:电子检索EMbase(1980-01/2011-05),MEDLINE(1966-01/2011-05),中国生物医学文献数据库(CBM,1978/2011-05)和中国期刊全文数据库(CNKI),筛查相关文章的参考文献.中文检索词冠状动脉支架,炎症因子,炎症,CRP,再狭窄,英文检索词为Coronary stent,inflammatory cytokines,inflammation,CRP,restenosis.结果与结论:临床试验结果显示支架置入后炎症反应明显加重,使用雷帕霉素药物洗脱支架,添加地塞米松、塞来昔布、瑞舒伐他汀等可更大程度上降低支架置入后炎症反应.动物试验发现使用雷帕霉素洗脱支架可减少支架置入段新生内膜的形成和缩小炎症面积.提示各种干预措施可降低支架置入后炎症反应从而降低远期再狭窄的发生,可进一步改良加以应用于临床观察其疗效.     

冠状动脉支架置入后相关炎症因子的变化及其干预

背景：冠状动脉粥样硬化性心脏病支架置入治疗后的炎症反应以及其严重程度与再狭窄明显存在相关性,医学工作者试图从中寻找新思路预防支架置入后再狭窄,提高治疗质量。目的：评价各种干预措施以及监测手段在冠状动脉置入术后炎症治疗中的应用价值和临床前景。方法：电子检索EMbase（1980-01/2011-05）,MEDLINE（1966-01/2011-05）,中国生物医学文献数据库（CBM,1978/2011-05）和中国期刊全文数据库（CNKI）,筛查相关文章的参考文献。中文检索词＂冠状动脉支架,炎症因子,炎症,CRP,再狭窄＂,英文检索词为＂Coronary stent,inflammatory cytokines,inflammation,CRP,restenosis＂。结果与结论：临床试验结果显示支架置入后炎症反应明显加重,使用雷帕霉素药物洗脱支架,添加地塞米松、塞来昔布、瑞舒伐他汀等可更大程度上降低支架置入后炎症反应。动物试验发现使用雷帕霉素洗脱支架可减少支架置入段新生内膜的形成和缩小炎症面积。提示各种干预措施可降低支架置入后炎症反应从而降低远期再狭窄的发生,可进一步改良加以应用于临床观察其疗效。     

护理干预对介入治疗术后失眠病人睡眠质量的影响

[目的]探讨护理干预对改善介入治疗术后失眠病人睡眠质量的有效性.[方法]将80例介入术后失眠病人按手术日期分为干预组(38例)和对照组(42例),对照组术后仅给予常规护理,干预组在此基础上针对失眠原因给予个性化综合护理干预.[结果]干预组入睡潜伏期、觉醒次数、睡眠时间显著优于对照组(P＜0.01),且干预组焦虑自评量表(SAS)得分较对照组降低(P＜0.01).[结论]针对失眠原因对术后失眠病人进行个性化综合护理干预可有效提高失眠病人的睡眠质量.     

Adaptation of a cardiac monitor for collection of infant sleep data and development of a computer program to categorize infant sleep state

This article describes the adaptation of a cardiac Holter monitor to more conveniently collect and store infant sleep data. The cardiac monitor was first adapted to connect to a sleep mattress, then refined until readable infant sleep signal data were produced. System data were compared to data collected by a live observer of infant sleep (kappa = 0.84). The IRB-approved testing used newborn infants, conducted with parental consent. Development of a rule-based computer program was designed to categorize the physiologic data into infant sleep wake states. The cardiac monitor was found to be lightweight, portable, battery powered, nonintrusive, and safe for collecting infant sleep data. Preliminary assessment of the validity of the program in scoring infant sleep was compared to hand scored data (kappa = 0.76). Refinement of the system and software program is ongoing and expected to greatly facilitate the study of infant state behavior.     

Making family-centered care a reality

Family-centered care means, in the broadest sense, welcoming the family as partners in the care of the child. Family-centered care challenges us to create a new vision of a hospital environment that works in a very different way and that can actually improve clinical outcomes. This report describes one hospital's journey into family-centered care--its accomplishments and its challenges. It should be noted that, although this report describes family-centered care in a children's hospital, the philosophy beautifully adapts to an adult facility.     

Improving day and night sleep problems in infants by changing day time sleep rhythm: a single group before and after study

This study explores the duration and timing of day time waking periods required for sleep disturbed infants to improve day and night sleep. Seventy-nine sleep disturbed outpatients with day and night sleep problems were investigated before and two weeks after a brief sleep intervention. Data were collected by interviewing parents on their infants’ day and night sleep patterns. Besides instructing the parents on night sleep regulation, they were advised to regulate day sleep. After the intervention, duration of day and night sleep increased and frequency of night waking decreased. The mean duration of the first waking period in the morning did not change, but the range decreased. The mean duration of the last waking period in the evening increased. The frequency of short and irregular day naps and the need for assistance in falling asleep decreased after the intervention. It is recommended that the last waking before night sleep is lengthened to reduce day and night sleep problems.     

以家庭为中心的干预对癫痫患儿适应行为的影响

目的 探讨以家庭为中心的干预对癫痫患儿适应行为的影响.方法 将98例癫痫患儿随机均分为研究组和对照组,各49例,对照组仅实施常规治疗、护理及健康教育,研究组在常规基础上实施为期1年的以家庭为中心的干预,于干预前及干预后1年采用儿童适应行为量表(SAB)进行效果评价.结果 干预前两组患儿SAB各分量表及独立功能因子、认知功能因子、社会/自制因子评分差异无显著性(均P＞0.05);适应行为等级为边界及以下的患儿两组亦无显著性差异(均P＞0.05);干预后研究组患儿SAB各分量表及独立功能因子、认知功能因子、社会/自制因子评分显著高于对照组(均P＜0.01);研究组适应行为等级为边界及以下的患儿显著低于对照组(P＜0.01).结论 以家庭为中心的干预有利于指导家长向患儿提供有效的家庭支持,可提高患儿的社会适应能力.     

个体化音乐干预对ICU肺癌患者术后睡眠质量影响的研究

目的 探讨个体化音乐干预对肺癌患者术后ICU期间睡眠质量的影响.方法 将240例患者随机分为观察组和对照组各120例.对照组给予常规术后护理,观察组在常规护理的基础上增加个体化音乐干预;对所有入组患者均于转出ICU当日采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表进行睡眠质量评定.结果 观察组睡眠障碍发生率(42.1％)明显低于对照组(56.3％),差异有显著意义(P＜0.05);观察组在主观睡眠质量、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能及PSQI总分方面均有所改善(P＜0.05);在入睡时间方面无改善(P＞0.05).结论 个体化音乐干预可以改善肺癌患者术后ICU期间的睡眠质量,促进伤口的修复、预防并发症,有利于患者术后恢复.