Jonathan Kushnir

Sleep of preschool children with night-time fears

BACKGROUND Night-time fears are very common in preschool and early school years. However, to date, the links between night-time fears and sleep have not been assessed systematically. The aim of this study was to evaluate natural sleep patterns in children with night-time fears, and to assess the association between parental fear-related strategies and childrens sleep disruptions. METHODS Sleep was assessed in a sample of 109 preschool children (64 boys and 45 girls) aged 4-6 years suffering from significant night-time fears, and in 30 healthy controls using actigraphy and parental reports. RESULTS Controls slept significantly better than the children with night-time fears. The disrupted sleep patterns of the children with night-time fears were reflected in a higher number of actigraphic night wakings, shorter periods of continuous sleep, shorter true sleep time, and a lower percentage of actual sleep time. Similar findings were manifested in sleep measures reported by the parents. Parental fear-management strategies were found to be linked to impaired actigraphic sleep measurements. CONCLUSIONS Children with night-time fears are at risk for developing poor sleep quality, which may further compromise their psychological well-being.

Coping with preoperative anxiety in cesarean section: physiological, cognitive, and emotional effects of listening to favorite music.

BACKGROUND Listening to music has a stress-reducing effect in surgical procedures. The effects of listening to music immediately before a cesarean section have not been studied. The objective of this study was to assess the effects of listening to selected music while waiting for a cesarean section on emotional reactions, on cognitive appraisal of the threat of surgery, and on stress-related physiological reactions. METHODS A total of 60 healthy women waiting alone to undergo an elective cesarean section for medical reasons only were randomly assigned either to an experimental or a control group. An hour before surgery they reported mood, and threat perception. Vital signs were assessed by a nurse. The experimental group listened to preselected favorite music for 40 minutes, and the control group waited for the operation without music. At the end of this period, all participants responded to a questionnaire assessing mood and threat perception, and the nurse measured vital signs. RESULTS Women who listened to music before a cesarean section had a significant increase in positive emotions and a significant decline in negative emotions and perceived threat of the situation when compared with women in the control group, who exhibited a decline in positive emotions, an increase in the perceived threat of the situation, and had no change in negative emotions. Women who listened to music also exhibited a significant reduction in systolic blood pressure compared with a significant increase in diastolic blood pressure and respiratory rate in the control group. CONCLUSION Listening to favorite music immediately before a cesarean section may be a cost-effective, emotion-focused coping strategy. (BIRTH 39:2 June 2012).

Correspondence between reported and actigraphic sleep measures in preschool children: the role of a clinical context.

STUDY OBJECTIVES The aim of this study was to assess the role of clinical context in determining the correspondence between actigraphic and reported sleep measures in preschool children. METHODS Sleep was assessed using actigraphy and parental reports in a clinical sample of 109 preschool children between the ages 4 and 6 years suffering from significant nighttime fears and in a sample of 30 healthy controls. RESULTS In comparison to actigraphy, parents in both groups indicated that their children fell asleep earlier and overestimated their sleep period. These gaps were significantly larger in the control group than the clinical group. Parents from both groups similarly underestimated the time their child was awake during the night in comparison to actigraphy. Significant correlations were found in both groups between parental reports and actigraphy sleep schedule measures. Low correlations were found for wake after sleep onset in both groups and for the number of night wakings. CONCLUSIONS Clinicians and researchers should be highly aware that parental reports on their childrens sleep may not be accurate, and that accuracy may be affected by the context of the study. The use of complimentary sleep assessment tools in clinical and research settings should be encouraged.

Nighttime fears of preschool children: A potential disposition marker for anxiety?

OBJECTIVE To examine if children who suffer from significant Nighttime Fears (NF) experience higher degree of general fears and behavioral problems and to explore whether effortful control mediates NF association with internalizing problems. METHODS One-hundred and nine preschool children (64 boys) between the ages 4 and 6years suffering from significant NF and 30 healthy children (16 boys) were evaluated using parental reports of behavioral problems [Child Behavior Checklist (CBCL)], parental and child report of fears [Fear Survey Revised for Parents (FSS-PC), Koala Fear Questionnaire (KFQ)], and a measure of effortful control derived from the Child Behavior Questionnaire (CBQ). RESULTS Children with severe NF also suffer from an increased level of a wide variety of fears other than NF, and exhibit more behavioral problems than controls both on parental and childrens measures of general fears, and main CBCL scale scores (Internalizing, Externalizing, Total score). Additionally, children with NF had lower abilities of effortful control (as manifested in CBQ attention and inhibitory control scales). Attention control mediated NF association to internalizing problems scale. CONCLUSIONS NF may serve as a marker for anxiety vulnerability, and this vulnerability might be mediated by abnormal attentional control. Our finding also highlights the need for a more comprehensive assessment of behavioral problems, fears and anxiety phenomena among children referred with NF.

The link between social anxiety disorder, treatment outcome, and sleep difficulties among patients receiving cognitive behavioral group therapy

OBJECTIVE The aim of our study was to examine the association between sleep disturbances and social anxiety disorder (SAD). Another aim was to explore the impact of cognitive behavioral group therapy (CBGT) for SAD on co-occurring sleep difficulties. METHODS Data were obtained retrospectively from patient files receiving CBGT for SAD. The sample included 63 patients with SAD (mean age, 30.42 years [standard deviation, 6.92 years]). There were 41 men and 22 women, of whom 41 participants completed the treatment protocol. Before treatment onset participants completed the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index, and several sociodemographic questions. On completion of the treatment protocol, the same measures were completed, with the addition of the Sheehan Disabilities Scale (SDS). RESULTS The results of our study suggest that: (1) subjective insomnia is associated with SAD severity even after controlling for depression severity and additional variables; (2) participants with SAD with co-occurring clinical levels of subjective insomnia present a more severe clinical picture both at treatment onset and termination; and (3) although CBGT lead to reduction in SAD and depression symptoms severity, it had no significant impact on co-occurring sleep difficulties. CONCLUSIONS Sleep difficulties predict SAD severity regardless of depressive symptoms and may be linked to a more severe clinical picture. Clinicians should be aware of these sleep difficulties co-occurring with SAD and consider implementing specific sleep interventions. Future studies should incorporate larger samples sizes from clinical populations outside of Israel.

Exploring physician perceptions of the impact of emotions on behaviour during interactions with patients

BACKGROUND There is relatively little research on affective influences on physician behaviour, especially on prescribing and referrals. Affects include transitory moods and lasting emotions. OBJECTIVES We explored physician perceptions of the impact of four mood states on perceived rates of five behaviours: talking with patients, prescribing medications and referrals for laboratory tests, diagnostic tests and specialists. We also examined whether burnout modified the impact of moods on behaviour. METHODS A total of 188 family physicians responded anonymously to a self-reporting questionnaire that assessed the perceived rate of behaviours when in a positive, negative, tired and nervous mood and burnout level. RESULTS Five analyses of variance with repeated measures on mood states and contrast analyses computed the effects of mood and burnout on the behaviours. The mood factor was found significant for each of the behaviours, in all P < 0.001. The respondents reported that on good mood compared with negative mood days, they talked more, prescribed less and referred less. The burnout factor was also significant: high compared with low burnout physicians had higher perceived rates of all referral behaviours. Significant mood × burnout interactions indicated that the effects of mood were stronger among high compared with low burnout physicians. CONCLUSIONS The physicians perceived that their moods had different effects on different behaviours: the negative mood decreased talking and increased prescribing and referral behaviours and vice versa for the positive mood. Burnout intensified the effects of moods. The incremental effects of negative moods and burnout may impair quality of health care and may be costly to health services.

Night diapers use and sleep in children with enuresis

OBJECTIVE We aimed to assess the association between night diapers use and sleep quality of school-aged children with enuresis. METHODS The sleep patterns of 72 school-aged children (ages 6-9 y) with enuresis referred to a clinic specializing in bladder disorders and 63 healthy control children were assessed. Sleep measures were derived from four to five monitoring nights of actigraphy and daily logs. RESULTS In comparison to controls, children with enuresis who did not wear night diapers had poorer sleep quality as reflected by both actigraphic measures (more activity during sleep and shorter periods of continuous sleep) and one reported measure (lower sleep quality). However, no differences were found on any of the sleep measures between children with enuresis wearing night diapers and controls. The reported sleep quality of all children with enuresis with and without night diapers was lower than controls. CONCLUSIONS Our results suggest that sleep patterns of school-aged children with enuresis who do not wear night diapers are impaired, and the sleep quality of children using night diapers is similar to those of healthy children. Thus, clinicians and healthcare providers should consider recommending sleeping with night diapers for untreated children with enuresis, based on its positive impact on sleep.

Quality of life of adult daughters of women with schizophrenia: Associations with psychological resource losses and gains

OBJECTIVE This study examined the relationship between perceived losses and gains of psychological resources and quality of life of adult daughters of women with schizophrenia. METHOD Thirty one adult daughters of mothers with schizophrenia (age range 30 to 50years) and thirty women of similar socio-demographic characteristics whose mothers were mentally healthy (the control group) participated in this study. RESULTS (a) Resource loss was higher and resource gains were lower among daughters of women with schizophrenia, compared to the control group; (b) despite resource gains total score of quality of life was significantly lower among daughters of mothers with schizophrenia compared to the controls; (c) daughters of mothers with schizophrenia had lower levels of family functioning, a higher level of negative emotions and a lower level of positive emotions; (d) resource gains moderated the negative relationship between resource loss and quality of life; (e) the most significant predictor of quality of life was the group (i.e. daughters of women with schizophrenia compared with controls); (f) quality of life was more strongly associated with resource loss than with resource gain. DISCUSSION The findings of this research underscore the importance of raising awareness of caregivers and healthcare authorities to the needs of the unique population of daughters of women diagnosed with schizophrenia for support and even treatment.