Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation.

INTRODUCTION: Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). We investigated spatial distribution of electrical reconnection during re-do procedures in patients with paroxysmal atrial fibrillation who had previous successful acute electrical PVI with either single irrigated tip, antral ablation (s-RF; n = 38) or multi-electrode, duty-cycled ablation (PVAC; n = 48). METHODS AND RESULTS: EP navigator, mapping and irrigated tip ablation catheters were used in all re-do procedures. Sites of reconnection were assessed in a 12-segment model. Baseline clinical and demographic characteristics were similar in both groups. The number of PVs reconnected per patient was similar in both groups (2.9 ± 0.9 and 3.2 ± 0.7 (p = 0.193), s­RF and PVAC, respectively), and each PV was equally affected. However, the inferior quadrant of the right lower PV was significantly more vulnerable to reconnection after previous PVAC ablation, whereas the superior quadrant of the right upper PV showed significantly more reconnection in the s­RF group. CONCLUSION: The overall number of PVs reconnected was equally high in both groups, and each PV was affected equally. However, there were significant differences in the spatial distribution of electrical reconnection. Better understanding of predilection sites for reconnection might help to improve the long-term success rate of PVI.

The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: a randomized controlled trial.

OBJECTIVE: Sleep problems are common and persistent during adolescence and can have negative effects on adolescents' mood. To date, studies that investigate the effects of sleep extension on adolescents' sleep and depressive symptoms are still lacking. This study aims to investigate the effects of gradual sleep extension combined with sleep hygiene advice in adolescents with chronic sleep reduction on objectively measured sleep, self-reported sleep problems and depressive symptoms. METHODS: Fifty-five adolescents with chronic sleep reduction (mean age: 15.44 years; 85.5% females) were included in the study. Participants were randomly assigned to either a sleep extension group (gradual sleep extension by advancing bedtimes in the evening and receiving sleep hygiene advice) or to a control group (no instruction). Sleep was measured with actigraphy during three weeks, the first week was the baseline week, and the last two weeks were the experimental weeks during which sleep was extended. Other outcome variables were self-reported sleep problems (daytime sleepiness, symptoms of insomnia and circadian rhythm sleep disorder) and depressive symptoms, which were assessed before and after the experimental manipulation. RESULTS: During the third week of the experiment, adolescents in the sleep extension group had earlier bedtimes, earlier sleep onsets, spent more time in bed and slept longer than adolescents in the control group. Their chronic sleep reduction, insomnia symptoms and depressive symptoms diminished significantly. In addition, there was a trend of improved circadian rhythm sleep disorder symptoms and sleep quality. CONCLUSION: Gradual sleep extension combined with sleep hygiene advice seems to have beneficial effects on sleep, self-reported sleep problems and depressive symptoms of adolescents with chronic sleep reduction. Although we cannot distinguish between the effects of sleep extension and sleep hygiene advice, the results suggest that advancing bedtimes can extend sleep and improve depressive symptoms.

The effects of sleep extension on sleep and cognitive performance in adolescents with chronic sleep reduction: an experimental study.

OBJECTIVE: To investigate the effects of gradual sleep extension in adolescents with chronic sleep reduction. Outcome variables were objectively measured sleep and cognitive performance. METHODS: Participants were randomly assigned to either a sleep extension group (gradual sleep extension by advancing bedtimes in the evening) or to a control group (no instruction). Our sample consisted of 55 adolescents (mean age, 15.44 y; 85.5% girls) with symptoms of chronic sleep reduction (loss of energy, shortness of sleep, sleepiness, and irritation). Sleep was monitored with actigraphy over 3 weeks; the first week was the baseline week and the last two weeks were the experimental weeks. Participants in the experimental group were instructed to extend their sleep during the week by gradually advancing their bedtimes by 5 minutes each night. Additionally participants were asked to prevent bedtime shifts on weekend nights. Cognitive performance was assessed before and after the experimental manipulation. RESULTS: During the last week of the experiment, adolescents in the sleep extension group had earlier bedtimes, earlier sleep onsets, spent more time in bed, and slept longer than adolescents in the control group. These results indicate that the experimental manipulation was successful and that adolescents in the experimental group fell asleep earlier and slept longer than adolescents in the control group. Furthermore some aspects of cognitive performance, especially visuospatial processing, significantly changed in the sleep extension group. CONCLUSION: Gradual sleep extension has beneficial effects on adolescents' sleep and is related to changes in some aspects of cognitive performance.

Stress in Adolescents with a Chronically Ill Parent: Inspiration from Rolland's Family Systems-Illness Model.

This article was inspired by Rolland's Family Systems-Illness (FSI) model, aiming to predict adolescent stress as a function of parental illness type. Ninety-nine parents with a chronic medical condition, 82 partners, and 158 adolescent children (51 % girls; mean age = 15.1 years) participated in this Dutch study. The Dutch Stress Questionnaire for Children was used to measure child report of stress. Ill parents completed the Beck Depression Inventory. Children filled in a scale of the Inventory of Parent and Peer Attachment measuring the quality of parent attachment. Both parents filled in the Parent-Child-Interaction Questionnaire-Revised. We conducted multilevel regression analyses including illness type, the ill parent's depressive symptoms, family functioning (quality of marital relationship, parent-child interaction, and parent attachment), and adolescents' gender and age. Four regression analyses were performed separately for each illness type as defined by disability (Model 1), and onset (Model 2), course (Model 3), and outcome of illness (Model 4). In all models, higher adolescent stress scores were linked to lower quality of parent-child interaction and parent attachment, and adolescents' female gender. The four models explained approximately 37 % of the variance in adolescent stress between individuals and 43-44 % of the variance in adolescent stress between families. Adolescent stress was not related to parental illness type. Our results partially supported the FSI model stating that family functioning is essential in point of child adjustment to parental illness. In the chronic stage of parental illness, adolescent stress does not seem to vary depending on illness type.

Problem behavior in children of chronically ill parents: a meta-analysis.

The aim of this meta-analysis is to examine whether children of chronically ill parents differ from norm groups in problem behavior. We report moderator effects and overall effect sizes for internalizing, externalizing and total problem behavior assessed by children and parents. In fixed effect models, we found a significant overall effect size for internalizing problem behavior (number of studies k = 19, total sample size N = 1,858, Cohen's d = .23, p < .01) and externalizing problem behavior (k = 13, N = 1,525, d = .09, p < .01) but not for total problem behavior (k = 7; N = 896). Effects for internalizing and externalizing problem behavior were larger in non-cancer studies, in samples including younger children and younger ill parents, in samples defined by low average SES and in studies including parents with longer illness duration. In addition, effects for externalizing problem behavior were larger in studies characterized by a higher percentage of ill mothers and single parents. With exclusive self-report, effect sizes were significant for all problem behaviors. Based on these results, a family-centered approach in health care is recommended.

Relations between parenting and externalizing and internalizing problem behaviour in early adolescence: child behaviour as moderator and predictor.

In this longitudinal study we investigated relations between parenting and externalizing and internalizing problem behaviour during early adolescence. First, we examined parenting effects on problem behaviour, including child behaviour as a moderator. Second, we examined child behaviour as predictor of parenting, also including moderator effects. A total of 650 13- to 14-year-olds filled out the Youth Self-Report and questionnaires about parenting at two times within a one-year interval. Relations between parenting and problem behaviour appeared to be stronger for externalizing than for internalizing problem behaviour. Both parenting effects and child effects were found. Parenting significantly predicted an increase in externalizing problem behaviour one year later. Adolescent's previous level of problem behaviour predicted changes in parenting (involvement and decisional autonomy granting). In addition, parental and child characteristics interacted in predicting outcome.

Mental health, parental rules and sleep in pre-adolescents.

A health-sleep model concerning the relationship of mental health and parental rules with time in bed and sleep quality has been developed on the basis of survey data collected from 448 children in the first trimester of the regular school year. The children had a mean age of about 11 years and were attending last two grades of primary school. The relations between mental health characteristics, parental rules concerning sleep, sleep environment, sleep quality and time in bed are analysed using a structural equation model. In addition to a latent variable for 'mental health', two uncorrelated latent variables had to be introduced for sleep to achieve a satisfactory fit. One latent variable is related to sleep quality (restorative sleep), and the other relates to lying awake in bed prior to sleep (awake in bed). Restorative sleep shows a strong relationship with mental health, and awake in bed is related to having an own bedroom.

Time in bed, quality of sleep and school functioning of children.

This study describes the relationship of time in bed and quality of sleep with concentration and functioning at school. Neurotic and psychosomatic symptoms have been used as control variables. The sample consisted of 449 Dutch children in the seventh and eighth grades of elementary school. The age of the children varied between 9 y 5 mo and 14 y 5 mo. Seven schools participated in the research, with a total of 18 classes. The results indicated that 43% of the children had difficulty getting up in the morning. Furthermore, 15% of the children reported sleep problems and 25% did not feel rested at school. Time in bed and sleep quality show no relationship with concentration. Sleep quality, feeling rested at school and less distinct bedtimes were clearly related to school functioning. Another result was that children who had no difficulty getting up displayed more achievement motivation. Being open to the teacher's influence and achievement motivation depended mainly on sleep characteristics. Not getting bored at school, self-image as a pupil and control over aggressive behaviour were also influenced by gender, age, neuroticism and neurosomaticism.

The excitation-adaptation model of pediatric chronic illness.

This article examines the value of the psychosomatic family model for the study of chronically ill children. Four conceptual problems arise in the discussion of this model: the unidirectional causality of the model; the function of the sick child for the family system; the pathology of the family characteristics; and the disease type. In the present study, we propose (a) that a distinction be made between uncontrolled and controlled forms of disease, and (b) that the family characteristics of "cohesion" and "adaptation" be examined in relation to the parental capacity for problem solving and the acceptance or rejection of the child by the parents. This is shown by means of empirical research. In this empirical study, 20 families with a child suffering from controlled asthma are compared with 20 families with a child suffering from uncontrolled asthma. Contrary to the assumptions derived from the psychosomatic family model, the results show significantly more cohesion and structure in the group with a child suffering from controlled asthma. The findings from this study are integrated in a new model for the study of chronic childhood illness--"the excitation-adaptation model." In this model, two circular processes are emphasized involving (a) the progress of the illness and the way in which parents and child deal with medication and medical advice (therapy compliance), and (b) the factors influencing the therapy compliance on the part of the parents, the family, and the child. By studying these factors in connection with the management of the illness, it should become clear whether family characteristics are adaptive or pathological.

Intractable or uncontrolled asthma: psychosocial factors.

The purpose of this study was to address the question of why, when there is a comparable severity of asthma, medical facilities, and treatments, some children develop controlled asthma whereas other children do not and are frequently ill. The major research questions pertained to whether families with a child with uncontrolled asthma differ from families with a child with controlled asthma as regards family characteristics and child-rearing attitudes, whether particular psychosocial variables relate to the severity of the asthma, and whether the interaction between the severity of the asthma and its controllability may clarify the role of psychosocial variables. Two studies were conducted, in which 70 asthmatic children (age range 9-15 years) and their families participated. The children and their caregivers were presented with measures assessing parental child-rearing attitudes, the problem-solving abilities of the caregivers, family functioning, and emotional disorders in the asthmatic children. Contrary to the assumptions derived from the psychosomatic family model, the findings of these studies suggest, among other things, that cohesion of family members and rigid manner of function of caregivers may have a positive rather than a negative influence on the welfare of the asthmatic child. In addition, controlled asthma was found to relate to the correct use of medication, which was predominantly evident in more structured and interdependent family environments. Of major importance is the conclusion that a distinction between controlled and uncontrolled asthma leads to a better insight into the role of psychosomatic variables than a distinction on the basis of the severity of the asthma.