Adolescent sleep duration: associations with social-cognitive determinants and the mediating role of sleep hygiene practices.

Insufficient sleep duration among adolescents is a widespread public health problem. Gaining better insight into social-cognitive determinants associated with adolescent sleep duration is necessary for developing effective preventive interventions to support healthy sleep. This study aimed to explore whether social-cognitive determinants regarding sufficient sleep duration were associated with sleep duration, and if these associations were mediated by collective sleep hygiene practices. Furthermore, we examined these associations for social-cognitive determinants related to not using media before bedtime and doing relaxing activities and considered whether these associations were mediated by specific sleep hygiene practices. Data were collected amongst second- and third-grade adolescents from 10 Dutch high schools. A total of 878 adolescents (mean [SD] age 13.3 [0.71] years) completed data on sleep duration, social-cognitive determinants of the Theory of Planned Behaviour (i.e., attitude, subjective norms from parents, subjective norms from peers, perceived behavioural control, intention), and sleep hygiene practices. Single- and multivariable path models were constructed and mediation by sleep hygiene practices was analysed by Monte Carlo simulation. All social-cognitive determinants except for subjective norms from peers were associated with longer sleep duration (p < 0.01). Sleep hygiene practices mediated all associations between social-cognitive determinants and sleep duration (mediation ranging from 16% to 72%). Although some of the significant associations and mediation disappeared in the multivariable model, behavioural arousal was the strongest mediator, but collective sleep hygiene practices and cognitive/emotional arousal also explained parts of the associations. The findings indicate that social-cognitive factors should not be overlooked when targeting adolescent sleep duration.

Measuring sleep health in primary school-aged children: A systematic review of instruments and their content validity.

STUDY OBJECTIVES: This review aimed to summarize instruments that measure one or more domains of sleep health (i.e. duration, quality, efficiency, timing, daytime sleepiness and sleep-related behaviors) in a general population of 4-12-year old children, and to assess these instruments' content validity. Other measurement properties were evaluated for instruments with indications of sufficient content validity. METHODS: A systematic literature search was performed in PubMed, PsycINFO, Web of Science, and EmBase. Methodological quality, content validity, and other measurement properties were assessed via the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Instruments with indications of sufficient content validity (i.e. relevance, comprehensiveness and comprehensibility) were further evaluated on other measurement properties (i.e. other aspects of validity, reliability, responsiveness). A modified GRADE approach was applied to determine the quality of evidence. RESULTS: Twenty instruments, containing 36 subscales, were included. None of the instruments measured all sleep health domains. For five (subscales of) instruments sufficient relevance and comprehensibility was found. The quality of evidence ranged from very low to moderate. For these five instruments all additional measurement properties were assessed. Sufficient results were found for structural validity (n = 1), internal consistency (n = 1), and construct validity (n = 1), with quality of evidence ranging from very low to high. CONCLUSIONS: Several (subscales of) instruments measuring domains of child sleep health showed good promise, demonstrating sufficient relevance, comprehensibility, and some also sufficient results on other measurement properties. However, more high quality studies on instrument development and the evaluation of measurement properties are required.PROSPERO registration number: CRD42021224109.

Effect Evaluation of a School-Based Intervention Promoting Sleep in Adolescents: A Cluster-Randomized Controlled Trial.

BACKGROUND: This study evaluated the effect of the school-based intervention Charge Your Brainzzz on adolescents' social-cognitive determinants, sleep hygiene and sleep duration and quality. METHODS: A cluster-randomized controlled trial was conducted with 972 students from 10 Dutch high schools. Schools were randomly allocated to the intervention (N = 5) or control condition (N = 5). Outcomes were measured with the digital Consensus Sleep Diary and via a digital questionnaire, based on valid measures. Data were collected at baseline (T0), ±1.5 weeks post-intervention (T1) and ±3 months post-intervention (T2). Mixed model analyses were performed to estimate the effects on social-cognitive determinants, sleep hygiene, and sleep outcomes. RESULTS: The intervention increased sleep knowledge post-intervention (b = 1.91; 95%CI: 1.22-2.60) and at follow up (b = 1.40; 95%CI: 0.70-2.10). The intervention was also effective in changing adolescents' attitudes (b = 0.10; 95%CI: 0.01-0.19) and perceived behavioral control (b = 0.11; 95%CI: 0.01-0.22) post-intervention. No positive changes were found regarding subjective norms, behavioral intentions, sleep hygiene, or sleep outcomes. CONCLUSIONS: The intervention improved adolescents' sleep knowledge, attitude, and perceived behavioral control. To significantly impact sleep health, theoretically sound and systematically developed interventions are needed which take into account the interplay between sleep, sleep-related behaviors, and adolescents' social and physical environment. CLINICAL TRIAL REGISTRATION: Trial name: Evaluation of the school-based intervention Charge Your Brainzzz promoting sleep in adolescents; URL: https://doi.org/10.1186/ISRCTN36701918; ID: ISRCTN36701918.

Predictors of Changes in Sleep Duration in Dutch Primary Schoolchildren: the ChecKid Study.

BACKGROUND: Healthy sleep duration is essential to health and well-being in childhood and later life. Unfortunately, recent evidence shows a decline in sleep duration among children. Although effective interventions promoting healthy sleep duration require insight into its predictors, data on these factors are scarce. This study therefore investigated (i) which individual (lifestyle), social and cultural factors, and living conditions and (ii) which changes in these factors might be associated with the changes in sleep duration of Dutch primary schoolchildren observed over time. METHOD: Data from the ChecKid study was used, a dynamic cohort study among 4-13-year-old children living in the city of Zwolle, the Netherlands. Associations between changes in sleep duration and individual (lifestyle) factors (i.e., age, sex, physical activity behavior, sugar-sweetened beverage consumption, screen behavior), social and cultural factors (i.e., parental rules, ethnicity), and living conditions (i.e., parental education, presence of screens in the bedroom, household size) were analyzed using multivariable linear regression. RESULTS: A total of 1180 children participated, aged 6.6 ± 1.4 years in 2009. Mean sleep duration decreased from 11.4 ± 0.5 h/night in 2009 to 11.0 ± 0.5 h/night in 2012. Older children, boys, children who used screens after dinner, children with greater computer/game console use, and children whose parents had low levels of education had a greater decrease in sleep duration. CONCLUSIONS: This article reports on one of the first large, longitudinal cohort studies on predictors of child sleep duration. The results of the study can inform future interventions aimed at promoting healthy sleep in primary schoolchildren.

Serum and crevicular fluid concentrations after a single oral dose of metronidazole.

Previous studies have shown that metronidazole is an effective chemotherapeutic agent in the treatment of certain types of periodontal disease. The purpose of this study was to assess, over 18 hours, the concentration of the drug in serum and gingival crevicular fluid after a single oral dose. Six female volunteers with gingivitis created by cessation of brushing for 2 weeks, took 250 mg of metronidazole orally. Micropipettes were used to collect 20 microliters of serum and 4 to 5 microliters of gingival fluid hourly for 8 hours, and at the 12th and 18th hours. Samples were assayed with a high pressure liquid chromatograph. Mean drug levels in serum closely matched those reported by Stephen et al. (Br Dent J 7: 313, 1966) with polography. Mean serum drug levels peaked at 6.09 micrograms/ml at the 2nd hour, and mean gingival crevicular fluid drug levels peaked at 3.62 micrograms/ml at the 2nd and 7th hours. The drug was detectable in both fluids for up to 18 hours. Mean serum concentrations remained greater than mean gingival fluid concentrations at all time intervals, though the differences were not significant (P less than 0.05) as determined by a Hoteling's T2 test. Using reported minimal inhibitory concentration values of metronidazole for various periodontopathogens, it was concluded that a single oral dose of metronidazole will deliver potentially inhibitory levels of the drug to the periodontium in serum and in gingival crevicular fluid.

An evaluation of daily bacteriologic monitoring to identify preventable episodes of catheter-associated urinary tract infection.

We evaluated the efficacy of a daily bacteriologic monitoring program for preventing symptomatic urinary tract infections (UTI) in hospitalized patients with temporary indwelling urethral catheters. We identified 99 instances in which bacteriuria was present at the time of catheter insertion among 1,140 catheterizations. Of those, 62 patients were asymptomatic and 37 patients had fever or symptoms attributable to UTI. Of the 37 symptomatic episodes, only 14 developed symptoms 24 hours or more after the first culture and might be considered potentially preventable. We also identified 76 episodes of acquired bacteriuria among 608 catheterizations that were initially nonbacteriuric in which at least two cultures were available. Of these 76 patients, 51 (67%) remained asymptomatic throughout their period of hospitalization. Of the 25 patients who developed symptomatic infections, only ten were potentially preventable. In all, only 24 symptomatic episodes among 1,140 catheterizations (2%) occurred 24 hours or more after colonization was first detected and might be considered potentially preventable. Our data suggest that routine daily bacteriologic monitoring of urine from all catheterized patients is not an efficient way to decrease the incidence of symptomatic, catheter-associated UTI.

Failure of bacterial filters to reduce the incidence of pneumonia after inhalation anesthesia.

The authors prospectively studied 520 patients undergoing inhalation anesthesia to evaluate the efficacy of low resistance 0.22-micron bacterial filters in preventing postoperative pneumonias. Patients undergoing elective thoracic, upper abdominal and lower abdominal surgeries were randomly assigned preoperatively to filtered and nonfiltered anesthesia circuits by a study nurse. A second study nurse, who was unaware of patient assignments, followed each patient for five postoperative days to identify possible pulmonary complications. Both groups of patients were similar in age, sex distribution, smoking history, prior pulmonary disease, types and duration of surgery, ASA physical status classification, and receipt of intraoperative antibiotics. No differences in rates of postoperative pneumonia were observed between patients assigned to filtered and nonfiltered circuits (16.7 per cent vs. 18.3 per cent, respectively, P = 0.73). Also no differences were observed when the incidences of other outcome criteria such as postoperative fever, abnormal chest x-ray, sputum production, or abnormal pulmonary physical exam findings were evaluated. The results suggest that bacterial gas filters do not influence the incidence of postoperative pneumonias and that routine use of these devices for this purpose is not cost-effective.

Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens.

To evaluate the efficacy of daily cleansing of the urethral meatus-catheter junction in preventing bacteriuria during closed urinary drainage, randomized, controlled trials of two widely recommended regimens for meatal care were completed. In 32 (16.0 percent) of 200 patients given twice daily applications of a povidone-iodine solution and ointment bacteriuria was acquired, as compared with 24 (12.4 percent) of 194 patients not given this treatment. In 28 (12.2 percent) of 229 patients given once daily meatal cleansing with a nonantiseptic solution of green soap and water bacteriuria was acquired, as compared with 18 (8.1 percent) of 23 patients not given special meatal care. There was no evidence in either trial of a beneficial effect of meatal care. Moreover, each of four different statistical methods indicated that the rates of bacteriuria were higher in the treated groups than in the untreated groups. In subsets of female patients at high risk in both studies significantly higher rates of bacteriuria were noted in the treated groups than in the untreated groups. Current methods of meatal care appear to be hazardous, as well as expensive, and cannot be recommended as measures to control infection.

Risk factors for postoperative pneumonia.

Prospectively studied were 520 patients undergoing elective thoracic, upper abdominal and lower abdominal surgeries to analyze risk factors for postoperative pneumonias. Over-all, pneumonias developed in 91 of the 520 patients studied (17.5 percent). The acquisition of pneumonia was highly associated with preoperative markers of the severity of underlying diseases such as low serum albumin concentrations on admission (P less than 0.005) and high American Society of Anesthesiologists pre-anesthesia physical status classification (P less than 0.0001). History of smoking (P less than 0.001), longer preoperative stays (P less than 0.0001), longer operative procedures (P less than 0.0001) and thoracic or upper abdominal sites of surgery (P less than 0.0001) were also significant risk factors for postoperative pneumonias. Although massive obesity, old age and male sex were also associated with increased incidences of pneumonia, statistical significance was lost when these variables were controlled for site or duration of surgery. We were able to identify risk factors for pneumonia and to define a subpopulation of patients in which the risk of pneumonia was negligible. The acquisition of pneumonia by a low-risk patient should alert the physician to the possibility of a potentially preventable nosocomial infection.

Membrane filter contact technique for bacteriological sampling of moist surfaces.

We used a membrane filter contact technique to pick up and grow bacteria from artificially contaminated surfaces. We were able to recover individual colony-forming units (CFU) of Staphylococcus aureus from a moist agar surface more efficiently with 3- and 5- micron membrane filters than with Rodac plates, velvet pads, velveteen pads, or smaller-pore membrane filters. The effective transfer of bacteria with the 3- and 5-micron membrane filters was 0.96 +/- 0.04 (standard error of the mean) and 0.99 +/- 0.04, respectively, as compared to 0.49 +/- 0.03 for Rodac plates, 0.09 +/- 0.01 velvet pad imprints, 0.05 +/- 0.01 for velveteen pad imprints, 0.27 +/- 0.02 for velvet pad rinses, 0.005 +/- 0.001 for velveteen pad rinses, 0.39 +/- 0.02 for 0.45-micron filters, and 0.85 +/-0.05 for 1.2 micron filters. In addition, the recovery of S. aureus from contaminated bovine muscle surfaces with the 5-microns membrane filter was similar to that of quantitative dilutions of biopsy material and was significantly higher than the recovery from Rodac plates. The 5-microns membrane filters on a paddle recovered 52 +/- 5 CFU/cm2 from artificially contaminated bovine skeletal muscle, the quantitative dilutions of biopsy recovered 69 +/- 5 CFU/cm2, and the Rodac plate recovered 5 +/- 3 CFU/cm2. Sampling of moist surfaces by the membrane filter contact technique is easy to perform and highly efficient; our data suggest that it could be employed for cultures of clinical surfaces such as surgical wounds or burns.

Topical agents alone in acne. A blind assessment study.

The comparative effectiveness of three comprehensive therapeutic programs was studied in 118 patients with mild to moderate acne vulgaris. A topical program of tretinoin, benzoyl peroxide, and water avoidance was found to be as effective as the more commonly employed program of systemic tetracycline therapy with topically applied tretinoin and better than a program using systemic tetracycline therapy with abradant cleansers. At 16 weeks of therapy for all groups, the degree of skin dryness correlated with lack of improvement. Skin dryness is established as an aggravating factor in both the pathogenesis and treatment of acne. The topical program was nonirritating, well accepted by patients, and less expensive than the other two regimens.

Infectious diseases in small hospitals. Prevalence of infections and adequacy of microbiology services.

In a 1-day prevalence survey nosocomial infections were found in 7.2% and community acquired infections in 20.4% of 525 patients hospitalized in 18 small hospitals. Pneumonia was the reason for admission in 11% of patients in small hospitals. The patterns of nosocomial infections and antibiotic usage in small hospitals are similar to those found in large hospitals. The adequacy of bacteriologic services was assessed using a process audit technique. The routine approach to common bacteriologic specimens and antibiotic disk susceptibility tests was frequently inadequate. Approaches used in large hospitals for the control of nosocomial infection and the performance of bacteriology tests were not practical for most small hospitals. Specific research into methods for doing clinically adequate bacteriology and approaches for the control of nosocomial infection in the small hospital setting are needed.

Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection.

In a prospective study, we determined that severity of underlying disease at time of admission indicates medical patients at unusual risk of nosocomial infection. The nosocomial infection rate was 23.6% in patients with fatal underlying disease, 9.6% in those with ultimately fatal disease, and 2.1% in those with nonfatal disease. After an awareness program that promoted the use of established methods for prevention of nosocomial infections was established, there was a decline of overall incidence of endemic nosocomial infections from 9.2% to 4.8% (P less than .001) within an eight-month period. With subsequent discontinuation of the program, the infection rate rose to 8.1%. Reinstitution of the program resulted in a decline to 5.2% (P = .05).

Haemophilus aphrophilus cholecystitis.

Cultures from the gallbladder and blood of a 60-year-old man with acute cholecystitis grew Haemophilus aphrophilus. This organism, an unusual isolate in clinical specimens, is most frequently seen in patients with either endocarditis or brain abscesses. Haemophilus aphrophilus may be distinguished from Eikenella corrodens and Actinobacillus actinomycetemcomitans on the basis of colonial morphology and the biochemical tests for oxidase and catalase production and fermentation of lactose, sucrose, glucose, mannitol, xylose, and trehalose.

Antimicrobial prophylaxis for catheter-associated bacteriuria.

We evaluated short-term systemic antimicrobial prophylaxis for catheter-associated bacteriuria in women undergoing elective gynecological operations in a prospective, controlled, double-masked study. Nine of 100 placebo-treated patients acquired bacteriuria during catheterization compared with 3 of 96 of the drug-treated group. However, at the time of hospital discharge, clean-voided urine specimens were positive as frequently in the drug-treated group (8 of 82 patients cultured) as in the placebo group (8 of 75 patients cultured). No difference in febrile morbidity due to bacteriuria was noted between the prophylaxis and placebo groups. The incidence of catheter-associated bacteriuria may be reduced by antimicrobial prophylaxis. However, because the protective effect is transient and is associated with the selection of resistant organisms, prophylaxis is not indicated for patients at low risk for acquired bacteriuria and in whom the sequelae of catheter-associated infections are infrequent.

Infection control in small hospitals. Prevalence surveys in 18 institutions.

In prevalance surveys of 18 small hospitals in the intermountain region, 20.4% of the patients had community-acquired infections and 7.2% had infections acquired in the hospital. The types of nosocomial infections and patterns of antibiotic usage were similar to those encountered in large hospitals. In the small hospitals, 49% of the suspected bacterial infection were cultured, whereas at a nearby large hospital 77% were cultured. Seventeen of these small hospitals had an infection-control committee but these committees were unable to assess adequately the extent of their nosocomial infection problems. Monitoring of the environment with bacterial cultures was a frequent practice; overall, a ratio of one environmental culture was performed to each three diagnostic cultures. These results indicate the need to develop and evaluate nosocomial infection control programs in small hospitals.