Showing papers by "Bradley Hospital published in 2005"

Children's sleep: an interplay between culture and biology.

Abstract: Pediatricians provide a major source of knowledge for parents about children's behavior and development, although their advice is largely based on their own cultural values and beliefs in interaction with their personal and clinical experience. This review presents cross-cultural aspects of children's sleep behavior in industrialized and complex modern societies and provides a basis for understanding dimensions and mechanisms of cultural differences. We submit that it is the interaction between culture and biology that establishes behavioral and developmental norms and expectations regarding normal and problematic children's sleep. Pediatricians need to recognize the cultural environment in which children live and be knowledgeable about how cultural beliefs and values of both families and physicians interact with the needs and biological characteristics of individual children.

Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion.

Abstract: ContextConcern exists about the effect of extended resident work hours; however, no study has evaluated training-related performance impairments against an accepted standard of functional impairment.ObjectivesTo compare post-call performance during a heavy call rotation (every fourth or fifth night) to performance with a blood alcohol concentration of 0.04 to 0.05 g% (per 100 mL of blood) during a light call rotation, and to evaluate the association between self-assessed and actual performance.Design, Setting, and ParticipantsA prospective 2-session within-subject study of 34 pediatric residents (18 women and 16 men; mean age, 28.7 years) in an academic medical center conducted between October 2001 and August 2003, who were tested under 4 conditions: light call, light call with alcohol, heavy call, and heavy call with placebo.InterventionsResidents attended a test session during the final week of a light call rotation (non–post-call) and during the final week of a heavy call rotation (post-call). At each session, they underwent a 60-minute test battery (light and heavy call conditions), ingested either alcohol (light call with alcohol condition) or placebo (heavy call with placebo condition), and repeated the test battery. Performance self-evaluations followed each test.Main Outcome MeasuresSustained attention, vigilance, and simulated driving performance measures; and self-report sleepiness, performance, and effort measures.ResultsParticipants achieved the target blood alcohol concentration. Compared with light call, heavy call reaction times were 7% slower (242.5 vs 225.9 milliseconds, P<.001); commission errors were 40% higher (38.2% vs 27.2%, P<.001); and lane variability (7.0 vs 5.5 ft, P<.001) and speed variability (4.1 vs 2.4 mph, P<.001) on the driving simulator were 27% and 71% greater, respectively. Speed variability was 29% greater in heavy call with placebo than light call with alcohol (4.2 vs 3.2 mph, P = .01), and reaction time, lapses, omission errors, and off-roads were not different. Correlation between self-assessed and actual performance under heavy call was significant for commission errors (r = –0.45, P = .01), lane variability (r = –0.76, P<.001), and speed variability (r = –0.71, P<.001), but not for reaction time.ConclusionsPost-call performance impairment during a heavy call rotation is comparable with impairment associated with a 0.04 to 0.05 g% blood alcohol concentration during a light call rotation, as measured by sustained attention, vigilance, and simulated driving tasks. Residents’ ability to judge this impairment may be limited and task-specific.

Experimental restriction of sleep opportunity in children: effects on teacher ratings.

Abstract: STUDY OBJECTIVE To determine the effects of experimental restriction of sleep opportunity on teacher ratings of academic performance and behavior in healthy normal children. DESIGN Home-based, within-subjects design in which participants followed 3 week-long sleep schedules-Baseline (self-selected), Optimized, and Restricted-while attending school, with order of conditions counter-balanced (Optimized and Restricted). PARTICIPANTS Seventy-four children (39 boys; aged 6 to 12 years, mean = 10) screened for medical and psychological health. MEASUREMENTS AND RESULTS Teachers masked to assigned hours of sleep completed paper-and-pencil questionnaires at the end of each study condition. Questionnaire items were selected from several published measures. Summary scores included Academic Problems, Hyperactive-Impulsive Behaviors, Internalizing, Oppositional-Aggressive, Sleepiness, Total Attention Problems, and Mean Severity of Attention Problems. Main effects of sleep condition were found forAcademic Problems, Sleepiness, Total Attention Problems, and Mean Severity of Attention Problems. Restricting sleep increased ratings of Academic Problems (medium effect) relative to both Baseline (P < .01, eta(p)2 = .11) and Optimized (P < .05, eta(p)2 = .10) conditions and increased the Mean Severity of Attention Problems (medium effect) relative to Baseline (P < .01, eta(p)2 = .12). CONCLUSIONS These findings provide experimental support for widely held beliefs about the importance of sufficient time-in-bed for academic functioning in children. Reducing sleep opportunity had a direct effect on academic performance, as rated by teachers, even among healthy students with no history of behavioral problems or academic difficulty. Findings also support insufficient sleep as a direct source of variability in the manifestation of attention problems but not hyperactivity.

Neurobehavioral assessment from fetus to infant: the NICU Network Neurobehavioral Scale and the Fetal Neurobehavior Coding Scale.

Abstract: This review provides an overview and definition of the concept of neurobehavior in human development. Two neurobehavioral assessments used by the authors in current fetal and infant research are discussed: the NICU Network Neurobehavioral Assessment Scale and the Fetal Neurobehavior Coding System. This review will present how the two assessments attempt to measure similar processes from pre to post-natal life by examining three main components of neurobehavior: neurological, behavioral and stress/reactivity measures. Assessment descriptions, strengths and weaknesses, as well as cautions and limitations are provided.