Midwives' engagement in smoking- and alcohol-prevention in prenatal care before and after the introduction of practice guidelines in Switzerland: comparison of survey findings from 2008 and 2018.

BACKGROUND: Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed specific guidelines for health professionals in perinatal care to strengthen their role in smoking and alcohol use prevention. One such example is the "Guideline on Screening and Counselling for prevention of cigarette smoking and alcohol consumption before, during, and after pregnancy" introduced by the Swiss Midwives Association in 2011. The current study assesses the changes in midwives' engagement in smoking and alcohol use prevention before (2008) and after the introduction of the Guideline (2018). Further, the current study examines differences across regions (German vs. French speaking regions), graduation years (before and after the introduction of the Guideline) and different work settings (hospital vs. self-employed). METHODS: Survey data were collected in 2008 (n = 366) and in 2018 (n = 459). Differences in how midwives engaged in smoking and alcohol use prevention between 2008 and 2018 were assessed with chi-square tests, as were differences across German and French speaking regions, graduation years (before and after the introduction of the Guideline) and across different work settings (working in hospitals or as self-employed). RESULTS: An increase in midwives' awareness of the risks of consuming even small quantities of cigarettes and alcohol for the unborn child between 2008 and 2018 is evident. Explaining the risks to pregnant women who smoke or use alcohol remained the most frequently reported prevention strategy. However, engagement with more extensive smoking and alcohol use preventive strategies across the whole course of pregnancy, such as assisting women in the elaboration of a plan to stop smoking/alcohol use, remained limited. CONCLUSIONS: Seven years after its introduction, the effectiveness of the Guideline in increasing midwives' engagement in smoking and alcohol use prevention appears limited despite midwives' increased awareness.

Multimethod Assessment of Attention, Executive Functions, and Motor Skills in Children With and Without ADHD: Children's Performance and Parents' Perceptions.

Objective: We examined whether children with attention-deficit/hyperactivity disorder (ADHD) differ from children without ADHD in attention, executive functions, and motor skills and whether measures of parents' perceptions and children's performance reveal comparable results. Method: About 52 children with ADHD and 52 children without ADHD aged 6 to 13 years completed performance-based measures of attention, executive functions, and motor skills. Parents completed questionnaires to rate their children's skills. Results: Parent questionnaires but not performance-based measures revealed higher inattention and lower executive function skills in children with ADHD compared to controls. For motor skills, both measurement methods revealed lower mean values and a higher number of children showing an impairment in the ADHD group. Parent-reported difficulties but not performance-based measures were related to the presence of an ADHD diagnosis. Conclusion: Our findings suggest that considering both parent questionnaires and performance-based measures will lead to a comprehensive picture of a child's strengths and difficulties.

Comparison of Blood Pressure and Kidney Markers between Adolescent Former Preterm Infants and Term Controls.

BACKGROUND: Preterm infants are at an increased risk of developing hypertension and chronic kidney disease later in life. No recommendations exist for blood pressure (BP) and renal follow up for these patients. AIM: To compare BP and serum and urinary kidney markers between preterm-born adolescents and term-born controls. METHODS: BP measurements in 51 preterm-born (≤32 weeks gestational age) and 82 term-born adolescents at the age of 10-15 years were conducted. Stepwise regression analysis explored the association between BP and participant characteristics. Kidney markers measured in the serum and urine were creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and uromodulin. Kidney markers measured in the serum were cystatin C, beta-2 microglobulin, and beta trace protein. RESULTS: Systolic BP was significantly higher in preterm boys compared with term boys, but not in girls, and low birth weight was associated with higher BP in boys. In the preterm group, maternal hypertension/preeclampsia and adolescent height were associated with higher systolic BP. Serum creatinine and NGAL were significantly higher in the preterm group. CONCLUSIONS: Our study confirms an inverse sex-dependant relationship between birth weight and BP at adolescent age. The higher serum creatinine and NGAL in the preterm group may indicate that premature birth affects kidney function in the long term.

The association between sleep and dual-task performance in preterm and full-term children: an exploratory study.

OBJECTIVES: The present study explored associations between sleep and children's dual-task performance using cognitive-motor dual tasks (eg, walking and talking). Previous research with older adults indicated correlations between higher gait variability and unfavorable sleep continuity variables. Based on this research, as a first objective, we investigated similar correlations in a sample of children. Second, we explored correlations between dual-task performance and dimensions of sleep architecture. Third, we tested moderating effects of prematurity on these associations. METHODS: In this study, 7-to 12-year-old children were tested in dual-task situations; of those, 39 were formerly preterm, and 59 were full-term born children. They were asked to walk and simultaneously perform different cognitive tasks. Gait was measured using an electronic walkway system. Sleep was measured using in-home sleep-electroencephalography. RESULTS: After accounting for age and cognition, regression analyses revealed correlations between a higher number of awakenings after sleep onset and lower dual-task performance; concerning sleep architecture, analyses revealed correlations between a higher amount of rapid-eye-movement (REM) sleep and lower gait variability. Furthermore, associations between a higher amount of slow wave sleep (SWS) and children's higher cognitive performance were found. Moderation analyses indicated no effects of prematurity. CONCLUSIONS: Our exploratory study suggests that a more disrupted sleep was related to children's poorer dual-task performance. Our findings support claims that REM sleep seems more related to performance in procedural tasks whereas SWS seems more related to performance in declarative tasks, suggesting that different sleep stages may support the processing of different performance types.

Correspondence of maternal and paternal perception of school-aged children's sleep with in-home sleep-electroencephalography and diary-reports of children's sleep.

OBJECTIVE: Parents are often the first to report children's sleep difficulties. The aim of the present study was to evaluate the accuracy of parent reports by examining the correspondence of maternal and paternal reports of children's sleep with in-home electroencephalography (EEG) sleep assessment and sleep diary reports. METHODS: A total of 143 children (57 formerly very preterm born children) aged 7-12 years underwent one night of in-home sleep-EEG; mothers and fathers reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire, and children and parents together completed a sleep diary of children's sleep. RESULTS: Less EEG-derived total sleep time (TST) was associated with increased mother questionnaire reports of sleep duration problems, while less sleep efficiency (SE) and longer sleep onset latency (SOL) were associated with increased mother questionnaire reports of sleep onset delay. For fathers, only longer SOL was related to increased father questionnaire reports of sleep onset delay. The abovementioned associations did not change with children's increasing age and did not differ for boys and girls. More parent questionnaire reports of sleep duration problems, sleep onset delay, and night wakings were related to shorter diary reports of sleep duration, increased sleep latency, and more nocturnal awakenings, respectively. CONCLUSIONS: Mother questionnaire reports of children's sleep corresponded moderately with objective measures of TST, SE, and SOL assessed with in-home sleep-EEG. Both mother and father questionnaire reports of children's sleep duration problems, sleep onset delay, and night wakings were related to diary reports of children's sleep.

Heart rate variability and salivary cortisol in very preterm children during school age.

The autonomic nervous system (ANS) plays a major role in the human stress response and reflects physical and psychological adaptability to a changing environment. Long-term exposure to early life stressors may alter the function of the ANS. The present study examines differences in the ANS between children born very preterm and full-term as well as the association between the ANS and the hypothalamic-pituitary-adrenal (HPA) axis, the other main branch of the human stress system. Fifty-four healthy children born very preterm (<32nd gestational week) and 67 full-term children aged 7-12 years provided data for the present study. Polysomnography (PSG) assessments were obtained during a night at the children's home in lying position at rest (wake) and during different sleep stages (stage 2 sleep, slow wave sleep, rapid-eye-movement sleep). Autonomic function was assessed by use of heart rate variability, specifically low frequency power (LF), high frequency power (HF), total spectral power (Tot Pow), and the LF/HF ratio. HPA axis activity was measured using salivary cortisol the next morning at awakening, 10, 20, and 30min later. Children born very preterm had lower LF/HF ratio during wake and stage 2 sleep compared to full-term children. Moreover, higher LF, Tot Pow, and LF/HF ratio during wake, stage 2 sleep, and REM sleep were related to more post-awakening cortisol secretion. The present study provides evidence on long-term ANS alterations after very preterm birth. Moreover, findings suggest a relation between the ANS and the HPA axis and therefore support the notion of mutual feedback between the two human stress systems.

The association of mothers' and fathers' insomnia symptoms with school-aged children's sleep assessed by parent report and in-home sleep-electroencephalography.

OBJECTIVE: Sleep plays an essential role for children's well-being. Because children's sleep is associated with parental sleep patterns, it must be considered in the family context. As a first aim of the present study, we test whether parental insomnia symptoms are related to children's in-home sleep-electroencephalography (EEG). Second, we examine the association between parental insomnia symptoms and maternal and paternal perception of children's sleep using actor-partner interdependence models. METHODS: A total of 191 healthy children enrolled in public school and aged 7-12 years took part in the study. Ninety-six were formerly very preterm born children. Children underwent in-home sleep-EEG, and parents reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire. Further, parents completed the Insomnia Severity Index to report their own insomnia symptoms. RESULTS: Maternal but not paternal insomnia symptoms were related to less children's EEG-derived total sleep time, more stage 2 sleep, less slow wave sleep, later sleep onset time, and later awakening time. Mothers' and fathers' own insomnia symptoms were related to their reports of children's bedtime resistance, sleep duration, sleep anxiety, night wakings, and/or daytime sleepiness. Moreover, maternal insomnia symptoms were associated with paternal reports of children's bedtime resistance, sleep anxiety, and sleep-disordered breathing. The associations between parental insomnia symptoms and parents' perception of children's sleep could not be explained by children's objectively measured sleep. CONCLUSIONS: Mothers' insomnia symptoms and children's objective sleep patterns are associated. Moreover, the parents' own insomnia symptoms might bias their perception of children's sleep-related behavior problems.

Effects of gestational age on brain volume and cognitive functions in generally healthy very preterm born children during school-age: A voxel-based morphometry study.

OBJECTIVE: To determine whether the relationship of gestational age (GA) with brain volumes and cognitive functions is linear or whether it follows a threshold model in preterm and term born children during school-age. STUDY DESIGN: We studied 106 children (M = 10 years 1 month, SD = 16 months; 40 females) enrolled in primary school: 57 were healthy very preterm children (10 children born 24-27 completed weeks' gestation (extremely preterm), 14 children born 28-29 completed weeks' gestation, 19 children born 30-31 completed weeks' gestation (very preterm), and 14 born 32 completed weeks' gestation (moderately preterm)) all born appropriate for GA (AGA) and 49 term-born children. Neuroimaging involved voxel-based morphometry with the statistical parametric mapping software. Cognitive functions were assessed with the WISC-IV. General Linear Models and multiple regressions were conducted controlling age, sex, and maternal education. RESULTS: Compared to groups of children born 30 completed weeks' gestation and later, children born <28 completed weeks' gestation had less gray matter volume (GMV) and white matter volume (WMV) and poorer cognitive functions including decreased full scale IQ, and processing speed. Differences in GMV partially mediated the relationship between GA and full scale IQ in preterm born children. CONCLUSIONS: In preterm children who are born AGA and without major complications GA is associated with brain volume and cognitive functions. In particular, decreased brain volume becomes evident in the extremely preterm group (born <28 completed weeks' gestation). In preterm children born 30 completed weeks' gestation and later the relationship of GA with brain volume and cognitive functions may be less strong as previously thought.