Review of implementation models for children's sleep support services in the UK.

Sleep deprivation has a serious impact on physical and mental health. Children with neurodevelopmental disorders are frequently affected by chronic insomnia, defined as difficulty in either initiating sleep, maintaining sleep continuity or poor sleep quality which can lead to long-term detrimental effects on behaviour, learning and development.Interventions to address chronic insomnia in children include both pharmacological and non-pharmacological approaches. While some children unequivocally benefit from pharmacological treatment, recommendations suggest an intervention based on cognitive-behavioural techniques involving a thorough assessment of the child's sleep pattern, environment and psychosocial factors supporting the child to learn to self-soothe as first-line treatment. Evidence from sleep clinics delivered by trained community practitioners supports the efficacy of an intensive programme, whereby education, practical advice and follow-up support were key factors; however, these services are inconsistently resourced. In practice, sleep support interventions range from verbal advice given in clinics to healthy sleep leaflets to tailored and non-tailored parent-directed interventions. Delivery models include promotion of safe sleep within a wider health promotion context and targeted early intervention within sleep clinics delivered in health and community services or by the third sector but evidence for each model is lacking.We describe a comprehensive whole systems city-wide model of sleep support, ranging from awareness raising, universal settings, targeted support for complex situations to specialist support, delivered according to complexity and breadth of need. By building capacity and quality assurance into the existing workforce, the service has been sustainable and has continued to develop since its initial implementation in 2017. With increasing access to specialist sleep services across the UK, this model could become a widely generalisable approach for delivery of sleep services to children in the UK and lead to improved outcomes in those with severe sleep deprivation.

A review of tobacco regulatory science research on vulnerable populations.

In 2013 the U.S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. This report reviews TCORS-funded research with adult vulnerable populations. The literature search included a list of all TCORS-funded publications compiled by the TCORS coordinating center; all TCORS were requested to share publications not in the coordinating-center's list. Only TCORS-funded reports describing an empirical study with an adult vulnerable population published in a peer-reviewed journal between September 2013 and June 2018 were included. 71 reports met inclusion criteria; 39% (28/71) examined tobacco use among those with mental health and medical comorbidities, 34% (24/71) socioeconomic disadvantage, 31% (22/71) women of reproductive age, 30% (21/71) racial/ethnic minorities, 18% (13/71) rural residents, and 3% (2/71) each among active military/veterans and sexual/gender minorities. Regarding scientific domains, 63% (45/71) investigated behavior, 37% (26/71) addiction, 24% (17/71) health effects, 20% (14/71) impact analyses, 18% (13/71) toxicity, 8% (6/71) marketing influences, and 7% (5/71) communications. Totals exceed 100% because some reports addressed multiple populations/domains. TCORS funding has generated a substantial, multidisciplinary body of new scientific knowledge on tobacco use in adult vulnerable populations. However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward.

Mechanical therapy for loss of knee flexion.

We hypothesized that adding home mechanical therapy to traditional physical therapy by a physical therapist would significantly reduce the need for surgical management of loss of knee flexion after surgery or injury. From 1990 to 1999, we followed up on 34 patients who added home mechanical therapy after failure of physical therapy alone. Thirty-one (91.2%) of these patients regained functional flexion (defined as flexion to 115 degrees) after 6.7 weeks. After surgery, these patients had waited a mean of 23.6 weeks before starting home mechanical therapy. Over the course of this therapy, mean knee flexion progressed from 70.8 degrees to 130.6 degrees. Only 2 patients in this study required surgical manipulation. We conclude that a home mechanical therapy program will reduce the need for surgical management of loss of knee flexion.