Noise exposure exceeded safe limits during neonatal care and road transport but was reduced by active noise cancelling.

AIM: Noise levels above 45 dB in a neonatal intensive care unit (NICU) and 60 dB during neonatal transport are recognised hazards, but protective equipment is not standard. We measured noise levels in both settings, with and without noise protection. METHODS: Peak sound and equivalent continuous sound levels were measured in a NICU and during road transport, at a mannequin's ear and inside and outside the incubator. Recordings were made without protective earwear, with noise protecting earmuffs and with active noise cancelling headphones. RESULTS: In the NICU, the peak levels at the ear, and inside and outside the incubator, were 61, 68 and 76 dB. The equivalent continuous sound levels were 45, 54 and 59 dB. During road transport, the respective levels were 70, 77 and 83 dB and 54, 62 and 68 dB. In the NICU, 80% of environmental peak noise reached the ear and this was reduced to 78% with earmuffs and 75% with active noise cancelling. The respective figures during transport were 87% without protection and 72% with active noise cancelling, with an unexpected increase for ear muffs. CONCLUSION: Noise levels exceeded safe limits in the NICU and during transport, but active noise cancelling reduced exposure.

Autogenic Training as a behavioural approach to insomnia: a prospective cohort study.

BACKGROUND: Insomnia is commonly associated with chronic health problems. Behavioural and cognitive factors often perpetuate a vicious cycle of anxiety and sleep disturbance, leading to long-term insomnia. National Institute for Health and Clinical Excellence currently recommends behavioural approaches before prescribing hypnotics. Behavioural approaches aim to treat underlying causes, but are not widely available. Research usually includes patients diagnosed with insomnia rather than secondary, co-morbid sleep- related problems. AIM: To examine the effectiveness of autogenic training (AT) as a non-drug approach to sleep-related problems associated with chronic ill health. DESIGN: Prospective pre- and post-treatment cohort study. SETTING: AT centre, Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Foundation Trust. METHODS: All patients referred for AT from April 2007 to April 2008 were invited to participate. Participants received standard 8-week training, with no specific focus on sleep. Sleep questionnaires were administered at four time points, 'Measure Your Medical Outcome Profile' (MYMOP) and Hospital Anxiety and Depression Scale, before and after treatment. Results before and after treatment were compared. Camden and Islington Community Local Research and Ethics Committee approved the study. RESULTS: The AT course was completed by 153 participants, of whom 73% were identified as having a sleep-related problem. Improvements in sleep patterns included: sleep onset latency (P = 0.049), falling asleep quicker after night waking (P < 0.001), feeling more refreshed (P < 0.001) and more energised on waking (P = 0.019). MYMOP symptom, well-being, anxiety and depression scores significantly improved (all P < 0.001). CONCLUSION: This study suggests that AT may improve sleep patterns for patients with various health conditions and reduce anxiety and depression, both of which may result from and cause insomnia. Improvements in sleep patterns occurred despite, or possibly due to, not focusing on sleep during training. AT may provide an approach to insomnia that could be incorporated into primary care.

Perceived changes associated with autogenic training for anxiety: a grounded theory study.

OBJECTIVES: Autogenic training (AT) is a behaviourally orientated intervention usually taught in eight or nine sessions in the United Kingdom: clients are taught six simple mental formulae designed to induce a calm state of mind and body, five additional emotional expression exercises, and individually tailored 'personal formulae' for supporting positive change. In the absence of existing psychological (as opposed to neuro-physiological) models of AT's mechanisms, this study aimed to produce the first such model, drawing on the perceptions of recent AT clients. DESIGN: An abbreviated form of grounded theory was used to explore retrospectively and in detail the experiences of a small sample of people of the process of change. METHODS: Forty people were approached and 12 women participated who had completed AT in group form after referral for anxiety. Each was interviewed individually. A preliminary model of change was produced, grounded in the interview data. RESULTS: Factors reported to be salient were learning in a group, the core AT experience (the six standard exercises), difficulties with practice, the importance of regular practice integrated into daily life, and enhanced well-being and coping, which incorporated reduced worrying and clearer thinking. Limitations of the study are discussed, as are areas for further research and implications for anxiety treatment. CONCLUSIONS: This was a small study with a self-selected sample. However, theoretical generalizations can be made about the process of change. Since AT does not specifically focus on challenging negative cognitions, the cognitive changes reported have implications for anxiety treatments.