Defining and measuring bedtime routines in families with young children-A DELPHI process for reaching wider consensus.

INTRODUCTION: Bedtime routines are one of the most common family activities. They affect children' wellbeing, development and health. Despite their importance, there is limited evidence and agreement on what constitutes an optimal bedtime routine. This study aims to reach expert consensus on a definition of optimal bedtime routines and to propose a measurement for bedtime routines. METHOD: Four-step DELPHI process completed between February and March 2020 with 59 experts from different scientific, health and social care backgrounds. The DELPHI process started with an expert discussion group and then continued with 3 formal DELPHI rounds during which different elements of the definition and measurement of bedtime routines were iteratively refined. The proposed measurement of bedtime routines was then validated against existing data following the end of the DELPHI process. RESULTS: At the end of the four round DELPHI process and with a consistent 70% agreement level, a holistic definition of bedtime routines for families with young children between the ages of 2 and 8 years was achieved. Additionally, two approaches for measuring bedtime routines, one static (one-off) and one dynamic (over a 7-night period) are proposed following the end of the DELPHI process. A Bland-Altman difference plot was also calculated and visually examined showing agreement between the measurements that could allow them to be used interchangeably. DISCUSSION: Both the definition and the proposed measurements of bedtime routines are an important, initial step towards capturing a behavioural determinant of important health and developmental outcomes in children.

Trait Mindfulness Is Associated With Lower Pain Reactivity and Connectivity of the Default Mode Network.

Mindfulness-based training reduces pain in clinical and experimental settings. Evidence suggests that these beneficial effects are facilitated via an increased focus on the present moment and a reduced emotional enhancement of pain. Most of the existing literature has focused on mindfulness as a learned skill and on the neural mechanisms that underlie the acquisition of this skill. It is unknown whether similar mechanisms are associated with trait mindfulness in the absence of training and whether these mechanisms confer the ability to cope with pain. To determine this, we measured trait mindfulness and pain responsivity in 40 healthy volunteers naive to mindfulness meditation. As a feature of interest, we targeted the default mode network (DMN), a network of interacting brain regions associated with processes such as introspective thought, mind wandering, and rumination. As extant studies have implicated the DMN in the beneficial effects of mindfulness, we examined resting-state connectivity of the precuneus, a core DMN node. Higher trait mindfulness was associated with higher pain thresholds (r = .43, P < .01) and lower pain catastrophizing (r = -.51, P < .01). Consistent with the neural mechanisms of trained mindfulness, higher trait mindfulness was associated with lower connectivity between the nodes of the DMN. It was also associated with higher connectivity between the DMN and somatosensory cortices. These findings are consistent with the processes taught in formal meditation training, namely increased focus on sensory experience and a decrease in emotional appraisal processes, indicating that behavioral and neurological mechanisms described in the interventional mindfulness literature also underlie trait mindfulness prior to any formal training. PERSPECTIVE: Mindfulness research mostly focuses on mindfulness as a trained skill rather than a trait. Consistent with trained-mindfulness studies, we demonstrate that mindfulness is associated with variations in neural connectivity linked to sensory and evaluative processes. These findings indicate that trait mindfulness serves as a marker for individual differences in pain coping.