Core competencies for health professionals' training in pediatric behavioral sleep care: a Delphi study.

The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks.

Barriers and facilitators of evidence-based practice in pediatric behavioral sleep care: qualitative analysis of the perspectives of health professionals.

Behavioral sleep problems are highly prevalent among young and school-aged children. Despite strong evidence for effective interventions, few children receive evidence-based care. In this study, 124 Canadian health professionals answered open-ended questions regarding barriers and facilitators of their provision of evidence-based behavioral sleep-related care, and responses were analyzed for content. Responses represented issues at an individual practice level, as well as broader systemic issues. The most frequently reported barrier and facilitator related to knowledge, training, and education. Other barriers included lack of time and institutional support, and facilitators included supportive sleep attitudes and beliefs. This study may inform the design of education programs for health professionals, and provides support for broader systems-level initiatives targeted at increasing evidence-based practice.

What do preschool-aged children do when they wake at night: toward an understanding of night-waking behaviors among community children.

Little is known about behaviors displayed by preschoolers during night-waking. Mothers (N = 203) of community preschoolers completed the Children's Night-waking Behavior Scale and measures of night-waking, co-sleeping, and daytime behavior. Approximately 1/2 of wakings involved calling out, getting out of bed, and requests for comfort; 1/4 involved activity, fear, or instrumental requests. Specific associations between night-waking behaviors, night-waking, and bedtime and daytime behaviors were observed; associations were not consistent across child gender and age. For example, comfort requests were associated with mothers' perceptions of sleep as problematic in 4- and 5-year-old children only (ρ = .42); activity requests were associated with hyperactivity for boys only (r = .36). Understanding night-waking requires consideration of factors beyond parenting, such as children's behavior, age, and gender.

Agreement with night-waking strategies among community mothers of preschool-aged children.

OBJECTIVE: To explore the night-waking schemas of mothers of preschool-aged children, using a new measure of agreement with night-waking strategies (Night-waking Vignettes Scale; NVS). METHOD: A community sample of 203 mothers (M age = 32 years, SD = 5.1) of 2- to 5-year-olds (M age = 3.4 years, SD = 1.0) provided demographic information and completed the NVS and measures of night-waking and general parenting behavior. RESULTS: Few mothers endorsed strong agreement or disagreement with limit-setting, active comforting, or rewards; mothers generally disagreed with punishment. Significant associations between agreement with night-waking strategies, child sex, and maternal educational attainment were observed; only agreement with punishment was correlated with general parenting. Agreement with night-waking strategies differed across the night-waking behaviors depicted in the NVS vignettes. Agreement with limit-setting and agreement with active comforting were correlated with night-waking. CONCLUSIONS: Mothers may be ambivalent about common night-waking strategies. Night-waking schemas appear to be complex.

Thoughts and affect experienced by parents of preschool- and school-aged children during night-waking interactions.

Measures of parents' cognitions have advanced our understanding of infants' sleep. But, few comparable measures exist for use with parents of preschool- or school-age children. The Parents' night-waking thoughts and affect questionnaire (PNTQ), a self-report measure of parents' thoughts and feelings when their children wake during the night, addresses this need. This scale was evaluated in two community samples of parents (N = 473). Sample 1 included preschool-age children (2-5-years-old), and Sample 2 included preschool- and school-age children (2-10-years-old). A subsample completed 1-month test-retest reliability for the PNTQ (n = 201). Parents completed the PNTQ and measures of agreement with night-waking strategies, parenting stress, mental health, and night-waking. The psychometric properties of the PNTQ (i.e., internal consistency, test-retest reliability; content, construct, and convergent validity) were evaluated. A four-factor solution (positive thoughts about limit-setting, positive thoughts about active comforting, concerns about limit-setting, and distress about night-waking) demonstrated adequate fit in Sample 1 (robust CFI = .900; robust RMSEA = .060), which was replicated in Sample 2 (robust CFI = .870; robust RMSEA = .080). Internal consistency (αc = .68-.88) and test-retest reliability (r = .46-.80) were acceptable across subscales and samples. There was good evidence for convergent validity in both samples-including correlating with parent-reported night-waking behaviour. The PNTQ is a promising measure of thoughts and affect related to night-waking experienced by parents whose children wake during the night. The PNTQ may increase understanding of parents' use of specific night-waking strategies and may account for resistance to employing alternate techniques. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sleep problems, tiredness, and psychological symptoms among healthy adolescents.

OBJECTIVE: To examine the contribution of adolescents' sleep problems and tiredness to psychological symptoms after accounting for shared risk and psychological co-morbidity. METHODS: Secondary analyses of cross-sectional data on 12-16-year-old (N = 980) adolescents without chronic illness, functional limitation, or developmental delay. Adolescents rated sleep problems, tiredness, and psychological symptoms. Parents provided information about risk factors, adolescent tiredness, and psychological symptoms. RESULTS: Prior to accounting for psychological co-morbidity, most sleep variables were significant correlates of adolescent-, but not parent-rated, psychological symptoms. After accounting for psychological co-morbidity: nightmares were associated with adolescent-rated anxiety/depression; sleeping more than others was associated with adolescent-rated aggression; trouble sleeping was associated with adolescent-rated attention problems, anxiety/depression, and withdrawal; and adolescent-rated tiredness was associated with adolescent-rated aggression and withdrawal. CONCLUSIONS: Studies examining sleep and psychopathology should control for psychological co-morbidity.

Concurrent associations among sleep problems, indicators of inadequate sleep, psychopathology, and shared risk factors in a population-based sample of healthy Ontario children.

OBJECTIVES: Examine the contribution of sleep problems and indicators of inadequate sleep to psychopathology among children after accounting for shared risk and comorbid psychopathology. METHODS: Secondary analyses of cross-sectional data on 4- to 11-year-old (N = 1,550) children without chronic illness or developmental delay or disability. Parents provided information about sleep problems, indicators of inadequate sleep, symptoms of psychopathology, and risk factors for psychopathology. Teachers provided information about indicators of inadequate sleep and symptoms of psychopathology. RESULTS: Adjusting for risk factors and comorbid psychopathology, sleeping more than other children was related to parent-rated aggression. Nightmares and trouble sleeping were related to parent-rated anxious/depressed mood. Sleep problems were not related to attention problems. Being overtired was related to parent- and teacher-rated psychopathology. CONCLUSIONS: Relations among sleep problems, indicators of inadequate sleep, and psychopathology are complex; accounting for potential confounding variables and considering sleep variables separately may clarify these relations.

Laser microsurgery in cell and developmental biology.

New applications of laser microbeam irradiation to cell and developmental biology include a new instrument with a tunable wavelength (217- to 800-nanometer) laser microbeam and a wide range of energies and exposure durations (down to 25 X 10(-12) second). Laser microbeams can be used for microirradiation of selected nucleolar genetic regions and for laser microdissection of mitotic and cytoplasmic organelles. They are also used to disrupt the developing neurosensory appendages of the cricket and the imaginal discs of Drosophila.

Induction of somatostatin immunoreactivity in cultured ciliary ganglion neurons by activin in choroid cell-conditioned medium.

We have previously shown that the expression of somatostatin-like immunoreactivity in cultured ciliary ganglion neurons is stimulated by a macromolecule found in choroid cell-conditioned medium (ChCM). Here, we present the following evidence that this somatostatin-stimulating activity (SSA) is activin: human recombinant activin induces somatostatin-like immunoreactivity in CG neurons; ChCM induces hemoglobin synthesis in K562 cells, a biological activity characteristic of activin; activin A-specific antibodies recognize a protein in ChCM; cultured choroid cells contain activin RNA; and SSA is inhibited by follistatin, a specific activin-binding protein. Thus, activin is likely to be a neurodifferentiation factor for CG neurons in vivo.

Cloning, expression during development, and evidence for release of a trophic factor for ciliary ganglion neurons.

Ciliary ganglion (CG) neurons undergo a period of cell death during development that may be regulated by the limited availability of trophic factor produced by their target tissues. We have previously reported the purification of a ciliary neurotrophic factor from adult chick sciatic nerve that we called growth promoting activity (GPA). Here we demonstrate that GPA can be purified and cloned from embryonic day 15 (E15) chick eyes, which contain all the target tissues of the CG. Our studies show the following: GPA mRNA is induced in embryonic chick eyes during the period of CG neuron cell death; GPA mRNA is expressed specifically in the layer of the eye that contains the targets of the CG and in primary cultures of smooth muscle cells isolated from the choroid layer of the eye; and biologically active GPA is released from cells transfected with a GPA cDNA.

ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations.

The ABCs of SLEEPING mnemonic was developed to serve as an organizing framework for common pediatric sleep recommendations. The mnemonic stands for 1) age appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) exercise and diet, 5) no electronics in the bedroom or before bed, 6) positivity 7) independence when falling asleep and 8) needs of child met during the day, 9) equal great sleep. This review examines the empirical evidence behind the practices and recommendations captured by the ABCs of SLEEPING mnemonic for children aged 1 to 12. A search was conducted of key electronic databases (PubMed, PsycINFO, CINAHL, & EMBASE) to identify English articles that included the concepts of sleep, insomnia, and/or bedtime. 77 articles were eligible for inclusion and were coded to extract key details and findings regarding the relations between sleep practices identified in the ABCs of SLEEPING mnemonic and sleep outcomes. Findings provided preliminary support for many of the recommendations that are commonly made to families regarding healthy sleep practices. However, more robust investigations are needed to better understand the causal contributions of healthy sleep practices to the onset and maintenance of children's sleep problems.

Synergy of activin and ciliary neurotrophic factor signaling pathways in the induction of vasoactive intestinal peptide gene expression.

Activin, a member of the transforming growth factor-beta superfamily, can regulate neuropeptide gene expression in the nervous system and in neuroblastoma cells. Among the neuropeptide genes whose expression can be regulated by activin is the gene encoding the neuropeptide vasoactive intestinal peptide (VIP). To investigate the molecular mechanisms by which activin regulates neuronal gene expression, we have examined activin's regulation of VIP gene expression in NBFL neuroblastoma cells. We report here that NBFL cells respond to activin by increasing expression of VIP mRNA. Activin regulates VIP gene transcription in NBFL cells through a 180-bp element in the VIP promoter that was previously characterized to be necessary and sufficient to mediate the induction of VIP by the neuropoietic cytokines and termed the cytokine response element (CyRE). We find that the VIP CyRE is necessary and sufficient to mediate the transcriptional response to activin. In addition, ciliary neurotrophic factor (CNTF), a neuropoietic cytokine, synergizes with activin to increase VIP mRNA expression and transcription through the VIP CyRE. Mutations in either the Stat (signal transducer and activator of transcription) or AP-1 sites within the CyRE that reduce the response to CNTF, also reduce the response to activin. However, mutating both the Stat and AP-1 sites within the wild-type CyRE, while reducing the separate responses to either activin or CNTF, eliminates the synergy between them. These data suggest that activin and CNTF, two factors that appear to signal though distinct pathways, activate VIP gene transcription through a common transcriptional element, the VIP CyRE.

Plasmid DNA is superior to viral vectors for direct gene transfer into adult mouse skeletal muscle.

Direct gene transfer into skeletal muscle offers several therapeutic possibilities. We assessed direct intramuscular injection of recombinant plasmids, adenovirus, or retrovirus in normal or regenerating muscles of mice. The incorporation and expression of reporter genes introduced by any of these three vectors is greater in regenerating than in mature muscle. In regenerating muscle, pure DNA and adenovirus result in equivalent numbers of fibers expressing reporter gene (> 10%), but adenovirus also induces considerable cellular infiltration. In mature muscle, recombinant DNA is better than adenovirus. Retrovirus failed to infect mature muscle fibers and was less effective than plasmid DNA or adenovirus in regenerating muscle. The surprisingly high relative efficiency of pure plasmid DNA suggests that this method will provide a simple, safe and viable alternative for gene therapy involving muscle tissue.