Herbal remedies: efficacy in controlling sleepiness and promoting sleep.

Difficulties with sleep and daytime sleepiness are common complaints among adults in the United States. During the past decade, the use of herbal preparations among adults increased from 2.5% to 12.4%. This article presents relevant aspects of the 1994 Dietary Supplements Health and Education Act that stimulated the proliferation of herbal medicinals and reviews the pharmacological properties of the most commonly available herbal wake-promoting and sedating products. Given the rapid increase in use of herbals, health care professionals need to educate themselves and their patients about the use of these preparations.

Differences in reported sleep need among adolescents.

Increased lifestyle demands and reduced sleep are reported to result in daytime sleepiness and impaired functioning for teenagers. A sample of 612 freshman urban high school students completed a questionnaire describing their sleep patterns and problems, along with sociodemographic information, daily activities, pubertal development, depressive mood, and morning-evening preference. About 63% of the respondents felt they needed more sleep on weeknights (MS group), experienced sleepiness that interfered with their schoolwork, and had problems with sleeping. The other group reported they got sufficient sleep on weeknights (SS group) and did not experience sleepiness problems to the same degree. However, both had similar weeknight sleep and daily activity patterns. The MS group reported an ideal sleep time of 9.2 h, about 2 h more than they were getting and 1 h more than the SS group ideal, and had a higher preference for later bed and waking times. In our sample, individual differences in biologic sleep need and quality of sleep may be emerging as early as 14 years of age.

Pupil noise is a discriminator between narcoleptics and controls.

The pupil light reflex has a long history of being able to indicate states of mental arousal, ranging from sleepiness to concentrated cognitive effort. Such mental states have usually been inferred from pupil diameter or pupil area movements relative to some reference; sleepiness, for example, is characterized by a smaller than average pupil while mental effort brings on a slightly larger pupil. But all pupil movements and associated states of arousal are accompanied by a persistent random pupil diameter motion which has previously been attributed to neurological noise, the noise apparently arising in the neurological controller of the pupil reflex control system. Our experiments and signal processing methods show that the amplitude of this pupil noise is an indicator of the sleeping disorder narcolepsy. Narcoleptics are found to have diminished pupil noise amplitudes relative to control subjects. Pupil noise is estimated by statistical procedures which yield unbiased noise measures in the form of six-dimensional Gaussian vectors. Each subject is associated with a Gaussian vector which is optimally projected onto a scalar axis so as to maximize the mean square distance between the narcoleptic and control samples. The Kullback-Leibler discrimination function is estimated and then evaluated for each projection as a means of discriminating narcoleptics from controls. The projected noise measures correctly classify 18 out of 20 subjects. The projected values also form the basis for supporting or rejecting a hypothesis of narcoleptic or control class membership. Parametric and nonparametric hypothesis tests suggest that, with probabilities close to one, narcoleptics and controls are distinguishable classes. To emphasize the importance of pupil noise as a diagnostic tool we present evidence from the neurophysiology literature indicating that Alzheimer's disease and narcolepsy have some of the same brainstem nuclei implicated. Further, Alzheimer patients and narcoleptics share some of the same disturbed sleep patterns.

Church-based education: an outreach program for African Americans with hypertension.

The goals of this education outreach demonstration study were to prepare a cadre of registered nurses (RN) as Church Health Educators (CHE), and to test the efficacy of a hypertension (HBP) education and support program in African American (AA) churches for persons with HBP in managing blood pressure (BP). In this two-phase study, RNs were prepared as CHEs in phase 1 and a convenience sample of 97 subjects with HBP was taught by the CHEs in phase 2. The intervention's content included the bases of HBP and HBP management strategies, and was taught in eight 1-hour sessions. Using a pre-test-post-test design, data on knowledge, social support and BP were collected at baseline (pre), post-intervention (post1) and 3 months post-intervention (post2). Major findings include: (1) there was a significant increase in knowledge scores from pre to post1 and post2 (P < or = 0.0001; F = 95.08; df = 1.79); (2) education, age and number of years with HBP explained 49% of the variance associated with HBP knowledge; (3) systolic BP (SBP) and mean arterial BP (MAP) significantly decreased from pre to post1 and post2 (SBP-p < or = 0.0001, F = 18.35, df = 1.91; MAP-p < or = 0.0001, F = 17.80, df = 1.86); (4) DBP significantly decreased from pre to post1 only (p < or = 0.008, F = 17.48, df = 1.91); and (5) relationships were found between social support and DBP, and social support and MAP. Issues that emerged from this study with implications for outreach programming include recruitment and retention, randomization, selective sampling, intervention design and use of volunteers.

The effect of drug therapy on the perceived symptom and ADL experiences of narcoleptics.

Medications for the treatment of narcolepsy consist of central nervous system (CNS) stimulants to control the somnolent symptoms and tricyclic antidepressants to control the rapid-eye-movement (REM) sleep related symptoms. Anecdotal information suggested that many narcoleptics perceive their symptoms, particularly their sleepiness, to be poorly controlled despite taking medication. This study was a secondary analysis which examined if drug therapy made a difference in the perceived symptom experience and ability to perform daily living activities (ADLs) as reported by narcoleptics. No significant association was found between CNS stimulant or tricyclic antidepressant drug therapy and the subjective ratings of narcoleptic symptoms, nor with the perceived ability to perform ADLs. While this study did not examine symptom ratings on and off drug therapy, these findings do suggest that narcoleptics may have to utilize behavioral strategies with their medication regimens to effectively cope with narcolepsy's adverse effects on daily life.

Neurological pupillary noise in narcolepsy.

Pupillometry has a long but inconclusive history as a means of measuring human alertness. Spontaneous pupillary oscillations in narcoleptics and the sleep deprived are a recognized but quantitatively elusive indication of alertness. Stimulation of the pupillary light reflex (PLR) has provided contradictory or confusion indications of alertness levels. Results from 10 diagnosed narcoleptics and 10 control subjects in which the PLR system was stimulated and a reliable (90%) discriminator derived for classifying narcoleptics and controls was reported. Random pupillary oscillations, which is called pupillary noise to distinguish these oscillations from spontaneous ones, were estimated from continuous pupil diameter recordings using a recursive least squares method applied to a subject-specific PLR system model. Pupillary noise sum of squares indicate that narcoleptics have significantly (P < 0.005) less PLR noise than controls. This difference was attributed to supranuclear inhibition of randomly active Edinger-Westphal neurons long hypothesized to be the source of random pupillary oscillations. This inhibition also has been suggested as a cause of PLR sensitivity to nocturnal sleep quality so it may be that these findings apply to the sleep deprived and not just specifically to narcoleptics.

Artifact management in pupillometry.

A detailed analysis of pupillometry data collection and handling procedures in the initial study uncovered a number of problems that threatened the integrity of the data, including improper procedures, lack of adherence to data collection rules, and inaccurate mathematical calculation of results. Substantial modifications in procedures were made to improve data collection and reduce artifact. With the increased sampling rate from 5 to 60 Hz and use of a videotape playback system, a more accurate and thorough method for removing artifact from pupillometry data was demonstrated in a subsequent study. The automated cleaning algorithm system proved to be efficient at detecting and removing artifact, as well as alerting users to artifact that might not be replaceable automatically. Additionally, this system provided another method of data storage, videotape, which was beneficial in reviewing the pupil behavior that was digitally recorded. Now that procedures for collecting pupil data and managing artifact have been objectively tested, steps can be taken towards establishing pupillometry as a reliable and valid screening tool for detecting excessive sleepiness.

Readability levels of selected hypercholesterolemia patient education literature.

OBJECTIVES: To assess the readability of selected hypercholesterolemia print materials, summarize the limitations of readability formulas, describe how expert judgement can be used to enhance readability determinations of printed materials, and discuss indirect and direct methods for assessing patient literacy levels. DESIGN: Descriptive, retrospective, convenience sample OUTCOME MEASURES: Readability of four AHA/NLHBI hypercholesterolemia patient education pamphlets by use of three readability formulas and the Reading Materials Checklist. RESULTS: The FOG, Fry, and SMOG formulas were used to calculate reading levels by two raters who independently applied the formulas to the same word passages chosen from the beginning, middle, and end of the pamphlets. The mean reading grade levels were 14.4, 15.8, 14, and 14.4, demonstrating that all four pamphlets were written for people with college level reading skills. The limitations of readability formulas such as variations in reading estimates were demonstrated. When expert judgement was applied with the Reading Materials Checklist, all pamphlets were found lacking in the areas of legibility, usability, and motivational appeal. CONCLUSIONS: The results indicate that the pamphlets may not be appropriate for use with most of the adults in the United States who may be candidates for hypercholesterolemia patient education. Because reading formulas are limited in the information they provide, expert judgement regarding readability of print materials should also be applied. Additionally, indirect and direct techniques need to be used to assess the literacy level of the patient population who will be using the printed materials.

The abilities and aptitudes of students must be considered in program design.

Are BSN students changing? Merritt says they are. Further, she says educators need to change their ways. They need to design programs for the average student, not for some ideal student who doesn't exist.

Learning style preferences of coronary artery disease patients.

Using the Patient Learning Style Questionnaire, the author examined differences in perceived learning styles of 125 subjects with coronary artery disease (CAD) for conditions and modes of learning commonly found in patient education. The relation of these preferences to selected personal demographic characteristics was also determined. The results indicate that these subjects most preferred organized, detailed instruction using oral and pictorial-graphic modes of presentation. Independent modes of instruction were less preferred. Additional research on the preferred learning style of CAD patients is needed to enable health professionals involved in CAD patient education to design teaching activities.

Reliability and construct validity of alternate forms of the CLS Inventory.

Learning style assessment measures the preferences for specific ways of learning in selected teaching-learning situations. The Learning Styles Inventory, which was constructed based on the Canfield model of learning style, assesses learning preferences that focus on selected motivational and environmental factors present in formal instructional situations. The study presented here was designed to determine the reliability and construct validity of Canfield's ipsative inventory, and an alternate normative form developed by the authors. Results suggest that the alternate form is at least as reliable as the original ipsative inventory, with a factor structure that is congruent with the Canfield learning styles model.

Learning style preferences of baccalaureate nursing students.

The Kolb and Canfield models of learning style were used to determine the relationship of age, and age and professional nursing employment experience to learning style preferences of basic and RN students respectively, and the differences in learning style preferences of basic and RN students. The age of basic students, and age and work experience of RN students did not account for differences in students' preferences for learning as defined by the Kolb and Canfield models of learning style. There were significant differences in the learning style preferences between basic and RN students for the conditions and modes of learning as defined by the Canfield model. However, these differences did not coincide with those that had been inferred from adult learning theory. Based on the finding of significant differences between the two student groups for this model, some alternative propositions about the ways adults prefer to learn were proposed.