scholarly journals 0999 Predictors Of Natural Resolution Of Behavioral Sleep Problems In Early Childhood

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A379-A379
Author(s):  
M M Garrison
Keyword(s):  
Primary Care ◽  
Early Childhood ◽  
Sleep Duration ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Primary Care Providers ◽  
Sleep Onset Latency ◽  
Care Providers ◽  
Meaningful Improvement

Abstract Introduction Primary care providers are often unsure which patients require treatment for behavioral sleep problems of early childhood vs. which are likely to improve without intervention. Given limited treatment resources as well as the time and cost burden that intervention can pose for families, it may be helpful to identify the predictors of children whose behavioral sleep problems are likely to resolve -- and stay resolved -- without active intervention. Methods Here, we use the control arm of a randomized trial of 2.5 to 5 year-old community-recruited children with behavioral sleep problems to examine the natural history of behavioral sleep problems and the predictors of resolution. Of 217 families in the control arm, 146 had inadequate mean sleep duration at baseline (< 10.5 hours/night per diary) and were eligible for inclusion in the analysis. Data were drawn from sleep diaries and parent report surveys conducted at baseline, 3 and 12 months. Improvement was defined as increased duration by either at least 60 min from baseline or by 30 min to at least 10.5 hours/night. We conducted an exploratory logistic regression to identify predictors of natural resolution. Results Of the 146 eligible families, 130 had follow-up data at both 3 and 12 months and were included in this analysis. Of those 130, only 22 (17%) had substantially improved sleep by 3 months follow-up, and 10 of these continued to have improved sleep duration at 12 months. The strongest predictors of natural improvement both at 3 and 12 months were female child sex, having either infant or school-aged siblings, CBQ low-intensity pleasure score (i.e., children who tend to respond positively to cuddling, reading, and other gentle activities), mean duration of sleep onset latency per diary, parent-reported parasomnias on the CSHQ, and age under 4 years. Conclusion These findings suggest that contrary to common beliefs of both primary care providers and parents, relatively few children will experience a clinically meaningful improvement in sleep duration without intervention. Support This work is supported by a grant from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD): 5R01HD071937.

scholarly journals Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Laney K. Jones ◽  
Megan McMinn ◽  
David Kann ◽  
Michael Lesko ◽  
Amy C. Sturm ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Care Providers ◽  
Lipid Levels ◽  
Framework Analysis ◽  
Lipid Clinic ◽  
Adherence Counseling ◽  
Clinically Significant

Abstract Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

scholarly journals Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

2021 ◽  
Author(s):  
Bente Storm Mowatt Haugland ◽  
Mari Hysing ◽  
Asle Hoffart ◽  
Åshild Tellefsen Haaland ◽  
Jon Fauskanger Bjaastad ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Length ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Sleep Onset Latency ◽  
Post Intervention ◽  
Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p <  0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

Abstract P199: Sleep Health Varies By Immigration Status And Acculturation Level In Women: Results From The American Heart Association Go Red For Women Strategically Focused Research Network

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Ivan A Samayoa ◽  
Nour Makarem ◽  
Vivian Cao ◽  
Moorea Maguire ◽  
Huaqing Xi ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Sleep Problems ◽  
Immigrant Women ◽  
Sleep Onset ◽  
Research Network ◽  
Sleep Onset Latency ◽  
Onset Latency ◽  
Immigration Status ◽  
Sleep Health ◽  
The Us

Introduction: The Healthy Immigrant Effect refers to the phenomenon that recent immigrants are on average healthier than their native-born counterparts. Greater immigrant acculturation to the US has been linked to increased risk of cardiovascular disease (CVD), frequently attributed to factors including the adoption of Western diets and decreased physical activity. While immigrants may have healthier habits than US adults, which may confer protection from CVD, there is little research on sleep health, particularly in immigrant women. Hypothesis: We hypothesized that immigrants, particularly those with greater acculturation, would have more sleep problems. Methods: Baseline data from a 1-y, community-based cohort of 506 women (61% racial/ethnic minority, mean age=37±16y) was used to evaluate cross-sectional associations between acculturation and sleep. Women self-reported their immigration status and national origin. Acculturation was measured from responses to questions regarding language preference, nativity (sorted by regions: Asia, Caribbean, Latin America, other), length of residency in the US, and age at immigration. Sleep duration, sleep quality, risk of obstructive sleep apnea (OSA) and insomnia were assessed using validated questionnaires. Logistic regression models adjusted for age, health insurance, education and BMI were used to evaluate associations between acculturation measures and sleep characteristics. Results: Women who were immigrants (n=176) reported lower mean sleep duration (6.60 ± 1.25 vs. 6.85 ± 1.22 h, p=0.02) compared to non-immigrants (n=323); non-immigrants were more likely than immigrants to sleep ≥7h/night (OR: 1.50, CI: 1.01-2.22, p=0.04). Women who immigrated to the US before vs. after age 25 y had lower odds of having sleep onset latency ≥26 min (OR:0.97, CI:0.95-1.00, p=0.03). Immigrant women living in the US >10y vs. <10y had more than 2-fold higher odds of having longer sleep onset latency (≥26 min) (OR:2.43, CI:1.09-5.41, p=0.03). Immigrants from the Caribbean were more likely than immigrants from other regions to be at a high risk for OSA (OR:2.65, CI:1.07-6.55, p=0.04). Conclusions: Compared to non-immigrants, immigrant women exhibit shorter habitual sleep duration. Sleep problems may vary by age of immigration, years lived in the US, and region of origin, as those who immigrated when they were older and those who had lived in the US>10 y required more time to fall asleep and Caribbean immigrants had higher OSA risk.

Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer

2021 ◽  
pp. 152483992110278
Author(s):  
Katie Cueva ◽  
Melany Cueva ◽  
Laura Revels ◽  
Michelle Hensel ◽  
Mark Dignan
Keyword(s):  
Primary Care ◽  
Cancer Risk ◽  
Culturally Relevant ◽  
Cancer Education ◽  
Primary Care Providers ◽  
Future Research ◽  
Cancer Information ◽  
Care Providers ◽  
Share Information

Background Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014–2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska’s tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion. Key Findings Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules. Implications for Practice and Further Research Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.

Sleep misestimation among older adults suffering from insomnia with short and normal objective sleep duration and the effects of cognitive behavior therapy

SLEEP ◽  
2020 ◽  
Author(s):  
Nicole Lovato ◽  
Gorica Micic ◽  
Leon Lack
Keyword(s):  
Older Adults ◽  
Sleep Duration ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Sleep Onset ◽  
Sleep Diary ◽  
Cognitive Behavior ◽  
Sleep Onset Latency ◽  
Normal Sleep

Abstract Study Objectives Compare the degree of sleep misestimation in older adults with insomnia presenting with objectively short relative to normal sleep duration, and investigate the differential therapeutic response on sleep misestimation between the proposed sleep duration phenotypes to cognitive-behavior therapy for insomnia (CBTi). Methods Ninety-one adults (male = 43, mean age = 63.34, SD = 6.41) with sleep maintenance insomnia were classified as short sleepers (SS; &lt;6 h total sleep time [TST]) or normal sleepers (NS; ≥6 h TST) based on one night of home-based polysomnography. Participants were randomly allocated to CBTi (N = 30 SS, N = 33 NS) or to a wait-list control condition (N = 9 SS, N = 19 NS). Sleep misestimation was calculated as the difference scores of subjective (sleep diary reported) and objective (derived from actigraphy) sleep onset latency (SOL), wake after sleep onset (WASO), and TST at pre- and post-treatment, and 3-month follow-up. Results Prior to treatment, perception of SOL, WASO, and TST did not differ between patients with objectively short sleep duration relative to those with objectively normal sleep duration. Patients’ perception of WASO and TST, improved immediately following treatment and at 3-month follow-up relative to the waitlist group. These improvements did not differ significantly between those with short or normal objective sleep duration prior to treatment. Conclusions The degree of sleep misestimation is similar for older adults suffering from chronic insomnia with short or normal objective sleep duration. Irrespective of objective sleep duration prior to treatment, CBTi produces significant improvements in sleep perception. Clinical Trial Registration Number ACTRN12620000883910

scholarly journals Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

2018 ◽  
Vol 10 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Lauren White ◽  
Ali Azzam ◽  
Lauren Burrage ◽  
Clare Orme ◽  
Barbara Kay ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Primary Care Providers ◽  
Treatment Recommendation ◽  
Care Providers ◽  
Hcv Treatment ◽  
Community Based

BackgroundAustralia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care.ObjectivesIn order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.DesignRetrospective analysis of a prospectively recorded HCV treatment database.InterventionsA nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care.Results327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38–56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%.ConclusionCommunity-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

Evaluation of coordination of cancer care between designated cancer hospitals and primary care providers: Results from a nationwide survey in Japan.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 84-84
Author(s):  
Taro Tomizuka ◽  
Tomone Watanabe ◽  
Satoru Kamitani ◽  
Takahiro Higashi
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Care Coordination ◽  
Cancer Care ◽  
Critical Path ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
Cancer Specialist

84 Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.

Sign in / Sign up

Export Citation Format

Share Document