Pediatric Death and Family Organ Donation: Bereavement Support Services in One Pediatric Health System.

Health care providers need to support families and provide resources when facing their child's death and potential organ donation. Aims of this retrospective chart review in a tertiary health care system were: (1) describe characteristics of pediatric organ donors compared to those who were not; (2) determine differences between services utilized by families who selected organ donation versus those who did not. From 2017 to 2023 of 288 pediatric deaths, 76 were organ donors and 212 did not donate. Organ donors' mean age at admission was 6.3 ± 5.8 years. Thirty-four (44.7%) participated in Honor Walks. Significant differences existed between organ donors and non-organ donors in patients who were diagnosed with SIDS (3.9% vs 13.2%; P = .025). This study provides additional data to help further our understanding of bereavement support services for families making difficult decisions regarding organ donation.

Environment and Culture, a Cross-Sectional Survey on Drivers of Burnout in Pediatric Intensive Care.

Very little data is available to understand the drivers of burnout amongst health care workers in the pediatric intensive care unit. This is a survey-based, cross-sectional, point-prevalence analysis within a single children's health system with two free-standing hospitals (one academic and one private) to characterize the relationship of demographics, organizational support, organizational culture, relationship quality, conflict and work schedules with self-reported burnout. Burnout was identified in 152 (39.7%) of the 383 (38.7%) respondents. No significant relationship was identified between burnout and demographic factors or work schedule. A more constructive culture (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.77-0.90; p < 0.001), more organizational support (OR, 0.94; 95% CI, 0.92-0.96; p <0 0.001), and better staff relationships (OR, 0.54, 95% CI, 0.43-0.69; p < 0.001) reduced odds of burnout. More conflict increased odds (OR, 1.25; 95% CI, 1.12-1.39; p < 0.001). Less organizational support ( Z ß = 0.425) was the most important factor associated with burnout overall. A work environment where staff experience defensive cultures, poor relationships, more frequent conflict, and feel unsupported by the organization is associated with significantly higher odds of burnout in pediatric critical care. The effect of targeted interventions to promote constructive cultures, collegiality, and organizational support on burnout in pediatric intensive care should be studied.

Methodological Challenge: Addressing Bots in Online Research.

Internet-based research has become useful for data collection, particularly because it reduces the time and resources required for recruitment. Although participant recruitment using social media is a scientifically and ethically sound methodology for many studies, this approach attracts fraudulent participants and Internet bots which can pose serious threats to sample validity and data integrity. We present several case examples of research studies in which bots were encountered and the procedures used to address them. In addition, we provide an overview of strategies researchers can use to mitigate the risks associated with Internet-based recruitment methods.

Experiences of College Students Who Are Newly Diagnosed With Type 1 Diabetes Mellitus.

PURPOSE: To gain insight and understanding of emerging adult experiences after a diagnosed with type 1 diabetes mellitus (T1DM) and prior to or during college life experiences. DESIGN AND METHODS: A qualitative research design using a focus group was conducted with 12 college students recently diagnosed with T1DM during emerging adulthood. The focus group took place during a College Diabetes Network retreat. Using Braun and Clarke's six phase process, two researchers independently conducted a thematic analysis from the transcribed, verbatim audiotaped narratives. RESULTS: The 12 participants attended colleges in 11 different states. The mean age was 21 years (SD = 6.3) and the majority were female (n = 7). Qualitative analysis revealed four themes: 1) diabetes affects all aspects of life and complicates college living; 2) college environment affects diabetes management; 3) diabetes diagnosis facilitates growth and maturity; and 4) strategies used for diabetes management in college. CONCLUSION: T1DM is complex to manage in the college environment. However, these emerging adults newly diagnosed with T1DM highlight strategies for diabetes management while in college and the pivotal role of pediatric providers play in the successful management of T1DM. PRACTICE IMPLICATIONS: Diabetes education for emerging adults in college requires an adaptive focus that supports the developmental needs of this population. Nurses should focus on teaching healthy, modifiable behaviors of sleep, physical activity, and nutrition to improve glycemic control as well as adapting to the college life choices.

Does sleep duration, napping, and social jetlag predict hemoglobin A1c among college students with type 1 diabetes mellitus?

AIMS: The first aim examined the relationship between sleep behaviors (duration, napping, and social jetlag) and hemoglobin A1c (HbA1c) among emerging young adults (EYAs) with T1DM between 18 and 25 years old, who are living on a college campus. The second aim characterized the gender differences in glucose management, sleep behaviors, caffeine intake, and nighttime technology. METHODS: A cross-sectional study of eligible participants used a convenience sample of eligible participants. Using Research Electronic Data Capture (REDCap), participants completed surveys about diabetes management, caffeine intake, nighttime technology use, and sleep-related behaviors. Data were analyzed using correlation and multiple linear regression to predict HbA1c from sleep behaviors, adjusting for covariates. RESULTS: Participants (N = 76) average years with T1DM was 10.25 ±â€¯5.70. Compared to females, males had a longer sleep duration lower HbA1c levels. HbA1c levels were negatively correlated with weekday sleep (r = -0.24, p = 0.03) and positively correlated with napping (r = 0.34, p = 0.003). After adjusting for covariates, participants who napped had a higher HbA1c level (ß = 0.74, p = 0.03) compared with non-nappers. CONCLUSIONS: Higher HbA1c levels were found among EYAs with T1DM in college who were nappers and had a longer sleep duration. Modifying sleep behaviors may be an appropriate target to improve glycemic control.

Are college students told by health care providers about their risk factors for developing diabetes?

BACKGROUND AND PURPOSE: Communication about risk factors for diabetes between nurse practitioners and college students may not be occurring as the prevalence of Type 2 diabetes increases. The purpose of this secondary analysis was to evaluate if college students are being told of their risk for diabetes based on known risk factors of weight, sleep, and depressive symptoms. METHODS: Descriptive, cross-sectional study was completed using National Health and Nutrition Examination Survey 2011-2012. Using listwise deletion for all variables in the analyses, the sample (N = 313) included college participants aged 18-25 years. Logistic regression model found that body mass index (BMI), sleep quantity, and gender were significant predictors of not being told one was at risk for diabetes. In those with a BMI >25 kg/m (n = 159), only 22% were told about their risk for diabetes by a health care provider. CONCLUSIONS: Nurse practitioners may not be recognizing the factors that affect on the development of prediabetes in college-age students or not providing guidance for measures to prevent the morbidity related to diabetes. IMPLICATIONS FOR PRACTICE: Nurse practitioners are in a prime position to identify individuals with overweight/obesity, poor sleep, and depressive symptoms and recommend lifestyle changes to prevent the onset of disease.

Effects of a service learning experience on confidence and clinical skills in baccalaureate nursing students.

BACKGROUND: Camp programs yield positive and lasting benefits for children. Integrating a summer camp into a nurse course with a service learning design fosters learning beyond the classroom and enhances community engagement. OBJECTIVE: The purpose of this study is to describe the nursing students' experience and perceived confidence after completing a service learning nursing course. DESIGN: This is a descriptive, qualitative research study that used reflection and a perceived confidence questionnaire. SETTING: The study was conducted in a school of nursing and surrounding university campus facilities during the diabetes camp. PARTICIPANTS: The participants (n=23) were nursing students who enrolled in the nursing course. METHODS: As part of the course requirements, students completed an eight item question confidence survey before and after the diabetes camp related to diabetes and camp management, and interpersonal abilities with patients, families, and healthcare professionals. Within 48-72h after diabetes camp, the students completed the reflection paper. The pre and post Confidence Surveys were analyzed using a t-test and thematic analysis was used to analyze the reflection paper. RESULTS: Overall, perceived confidence levels increased after completing the service learning course (t=-9.91, p=0.001). Four themes emerged from the qualitative analysis: pre-camp assumptions and fears, growth in confidence, understanding diabetes management in the community, and appreciation for learning beyond the classroom and hospital setting. CONCLUSIONS: This service learning course provided nursing students the ability to not only develop diabetes clinical skills and perceived confidence, but also life skills including teamwork, leadership, and conflict resolution.

Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting.

BACKGROUND: Shortened sleep duration is associated with poor health and obesity among young children. Little is known about relationships among nighttime sleep duration, sleep behaviors, and obesogenic behaviors/obesity among toddlers. This study characterizes sleep behaviors/duration and examines relationships with obesogenic behaviors/obesity among toddlers from low-income families. METHODS: Mothers of toddlers (age 12-32 months) were recruited from urban/suburban sites serving low-income families. Mothers provided demographic information and completed the Brief Infant Sleep Questionnaire (BISQ); a 6-item Toddler Sleep Behavior Scale was derived (TSBS-BISQ, higher score reflects more recommended behaviors). Toddler weight/length were measured; obesity defined as ≥95th percentile weight-for-length. Measures of obesogenic behaviors: physical activity [accelerometry, minutes/day in Moderate-to-Vigorous Physical Activity (MVPA)] and diet quality [24-hour recall, Healthy Eating Index 2005 (HEI-2005)]. Bivariate and adjusted multivariable models examined associations between nighttime sleep behaviors/duration and obesogenic behaviors/obesity. RESULTS: Sample included 240 toddlers (mean age = 20.2 months), 55% male, 69% black, 59% urban. Toddlers spent 55.4 minutes/day in MVPA, mean HEI-2005 score was 55.4, 13% were obese. Mean sleep duration was 9.1 hours, with 35% endorsing 5-6 recommended sleep behaviors (TSBS-BISQ). In multivariable models, MVPA was positively related to sleep duration; obese toddlers had a shorter nighttime sleep duration than healthy weight toddlers [odds ratio = 0.69, p = 0.014]. Nighttime sleep duration was associated with high TSBS-BISQ scores, F = 6.1, p = 0.003. CONCLUSIONS: Toddlers with a shorter nighttime sleep duration are at higher risk for obesity and inactivity. Interventions to promote healthy sleep behaviors among toddlers from low-income families may improve nighttime sleep duration and reduce obesogenic behaviors/obesity.

Wired at a young age: the effect of caffeine and technology on sleep duration and body mass index in school-aged children.

INTRODUCTION: Two problems affecting school-aged children in the United States are inadequate sleep and an increased prevalence of obesity. The purpose of this study was to quantify media-related technology use and caffeine consumption in order to assess their potential effects on sleep duration and body mass index (BMI) in children. METHODS: The study was a secondary analysis of children 6 to 10 years of age (N = 625) from the National Sleep Foundation's Sleep in America Poll. Regression analysis was used to assess the relationship between caffeine and technology use, sleep variables, and BMI, adjusting for age, race, gender, and general health. RESULTS: Almost 30% (29.5%) of the children consumed a daily caffeinated beverage, and 42.4% had a television in the bedroom. Children who drank caffeinated beverages had 15 fewer minutes of sleep per night than did children who did not drink such beverages (b = -0.27, p = .002). Children with three technology items in their bedroom received 45 fewer minutes of sleep than did children without these items in their bedroom (b = -0.75, p = .010). Having adjusted for variables, only drinking caffeinated beverages was associated with a BMI z score. DISCUSSION: The complex relationships between caffeine intake and the use of technology with shortened periods of sleep and increased BMI need further study. Future research should explore how these risk factors for shortened periods of sleep can be modified in this young population.

Shortened sleep duration does not predict obesity in adolescents.

Obesity continues to be a major public health issue. In adolescents, there are limited studies on the relationship between obesity and sleep duration. We found hypothesized that an average sleep duration of <6 h in adolescents was associated with obesity. Data were from the National Longitudinal Study of Adolescent Health (ADD Health); a survey of 90,000 youths, aged 12-18 years; surveyed in several waves. The sample population for our study was 13,568. Weighted multiple logistic regression was used to identify the relationship between obesity at Wave II and sleep duration, having adjusted for skipping breakfast ≥ 2/week; race, gender, parental income, TV ≥ 2 h per day, depression, and obesity at Wave I. At Wave I, the mean age was 15.96 ± 0.11 years; mean sleep hours were 7.91 ± 0.04. At Waves I and II, respectively, 10.6 and 11.2% of adolescents were obese. Adjusted analyses suggest that the effect of shortened sleep duration in Wave I was not significantly predictive of obesity in Wave II (P < 0.218). Longitudinally, depression and TV ≥ 2 h per day at Wave I was associated with a higher risk of obesity at Wave II in adjusted analyses. Depressed adolescents were almost twice as likely to be obese (OR = 1.84, 95% CI = 1.25-2.72); adolescents who watched TV ≥ 2 h per day were 37% more likely to be obese (OR = 1.37, 95% CI = 1.09-1.72). Environmental factors including TV ≥ 2 h per day and depression were significantly associated with obesity; shortened sleep duration was not. Future longitudinal studies in adolescents are needed to determine whether timing of television watching directly influences sleep patterns and, ultimately, obesity.

Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning.

OBJECTIVE: Adolescents may not receive the sleep they need. New media technology and new, popular energy drinks may be implicated in sleep deficits. In this pilot study we quantified nighttime technology use and caffeine consumption to determine effects on sleep duration and daytime behaviors in adolescents. We hypothesized that with increased technology use, adolescents increase caffeine consumption, resulting in insufficient sleep duration. PATIENTS AND METHODS: Subjects were recruited from a pediatric office in a proximal suburb of Philadelphia, Pennsylvania. Inclusion criteria for this study were middle and high school subjects aged 12 to 18 years old. The questionnaire, Adolescent Sleep, Caffeine Intake, and Technology Use, was developed by the investigators to measure adolescents' intake of caffeinated drinks, use of nighttime media-related technology, and sleep behaviors. Descriptive statistics characterized the subjects, their caffeine and technology use, and sleep variables. Regression models assessed the relationships between caffeine, technology use, and sleep variables, having adjusted for age, race, gender, and BMI. RESULTS: Sleep was significantly related to the multitasking index. Teenagers getting 8 to 10 hours of sleep on school nights tended to have 1.5- to 2-fold lower multitasking indices compared with those getting less sleep. Thirty-three percent of the teenagers reported falling asleep during school. Caffeine consumption tended to be 76% higher by those who fell asleep. The log-transformed multitasking index was significantly related to falling asleep during school and with difficulties falling asleep on weeknights. CONCLUSIONS: Many adolescents used multiple forms of technology late into the night and concurrently consumed caffeinated beverages. Subsequently, their ability to stay alert and fully functional throughout the day was impaired by excessive daytime sleepiness. Future studies should measure more than television hours when evaluating the impact of nighttime activities on sleep patterns in adolescents.

Sleep-related dissociative disorder in a 6-year-old girl.

Sleep-related dissociative disorders are parasomnias that can emerge at any point during the sleep period and are associated with traumatic life experiences. No reports to date have described this parasomnia in a school-age child. This case report discusses presentation, diagnosis, and treatment of a 6-year-old girl with this diagnosis. Sleep-related dissociative disorder should be considered in young children who have experienced traumatic life events and who present with abnormal sleep patterns and bizarre behavior. Early identification and intensive psychotherapy can be efficacious for these children.