Appetite Stimulants for Treatment of Protein Energy Wasting of Chronic Kidney Disease.

Nutritional and metabolic abnormalities, or protein energy wasting, is a common complication of chronic kidney disease, leading to significant morbidity and mortality. The cause of these abnormalities is multifactorial, and therefore, difficult to treat. The International Society of Renal Nutrition and Metabolism suggests appetite stimulants, including megestrol, dronabinol, mirtazapine, and cyproheptadine, as adjunctive treatment options in addition to parenteral or oral nutritional supplementation. This article reviews the evidence for use of these drugs as appetite stimulants and discusses their use in patients with chronic kidney disease.

The curious incident of the dog in the nighttime: The effects of pet-human co-sleeping and bedsharing on sleep dimensions of children and adolescents.

BACKGROUND: Pets are often thought to be detrimental to sleep. Up to 75% of households with children have a pet, and 30-50% of adults and children regularly share their bed with their pets. Despite these high rates, few studies have examined the effect of pet-human co-sleeping on pediatric sleep. This study compared subjective and objective sleep in youth who never, sometimes, or frequently co-slept with pets. METHODS: Children (N = 188; aged 11-17 years; M = 13.25 years) and their parents answered standardized sleep questionnaires assessing timing, duration, onset latency, awakenings, and sleep quality. Children completed a home polysomnography (PSG) sleep study for one night and wore an actigraph for two weeks accompanied with daily sleep diary. Based on reported frequency of bedsharing with pets, children were stratified into three co-sleeping groups: never (65.4%), sometimes (16.5%), frequently (18.1%). RESULTS: Overall, 34.6% of children reported co-sleeping with their pet sometimes or frequently. Results revealed largely identical sleep profiles across co-sleeping groups; findings were congruent across sleep measurement (subjective: child, parent report; objective: PSG, actigraphy). Effect sizes indicated that frequent co-sleepers had the highest overall subjective sleep quality, but longest PSG onset-latency compared to the sometimes group. CONCLUSIONS: Co-sleeping with pets was prevalent in one third of children. Sleep dimensions were similar regardless of how frequently children reported sharing their bed with their pet. Future research should examine dyadic measurement of co-sleepers to derive causal evidence to better inform sleep recommendations.

Parental Expectations Are Associated with Children's Sleep Duration and Sleep Hygiene Habits.

OBJECTIVE: Although parents recognize the importance of sleep, most have a limited understanding of children's sleep needs. This study examined whether parental expectations about sleep were linked to children and adolescent's sleep duration and sleep hygiene. METHOD: Participants included 376 unique parent-child dyads. Parents (mean age = 47.0 years, SD = 6.7) estimated the number of hours of sleep their children (mean age = 13.0 years, SD = 2.2; 9-17 years) needed. These estimates were age-matched with recommended pediatric guidelines of the American Academy of Sleep Medicine and the National Sleep Foundation to yield 3 groups: expect less (8%-11%), expect appropriate (85%-89%), and expect more (3%-4%). Sleep duration for school nights and weekends were reported by children and parents. Sleep hygiene included sleep-promoting practices (quiet, dark bedroom, regular bed/wake times, consistent routine) and sleep-interfering practices (physiological arousal, presleep worry, alcohol/smoking intake, daytime napping, screen time). RESULTS: Most parents (68.7%) endorsed that children do not get enough sleep. Linear and logistic regressions were used to assess the impact of parental expectations. For every additional hour of sleep expected, children slept between 15.5 (parent-report 95% confidence interval [CI], 9.0-22.0) and 17.9 minutes (child-report 95% CI, 9.7-26.2) longer on school nights, adjusted for age, sex, puberty, and parental education. For parents who expected less sleep than recommended, their children had the shortest sleep duration, least favorable sleeping environments, and greater presleep worry. CONCLUSION: Parental sleep expectations were directly linked to children's sleep duration. Pediatricians and primary care providers can mobilize knowledge to optimally convey accurate information about developmental sleep needs and recommended hours to parents to promote longer sleep.

A decade's difference: 10-year change in insomnia symptom prevalence in Canada depends on sociodemographics and health status.

INTRODUCTION: Insomnia is recognized as a public health issue. The objectives of this study were to characterize and compare the prevalence of insomnia symptoms in the Canadian population in 2002 and 2012, and to identify sociodemographic and psychosocial predictors of trouble sleeping. METHODS: Data from adult participants in the Canadian Community Health Survey-Mental Health cycles 2000-2002 (n = 34,118) and 2011-2012 (n = 23,089) were used. Participants responded to the question "How often do you have trouble going to sleep or staying asleep?", with those who indicated "most of the time" or "all of the time" classified as having insomnia symptoms. Logistic regressions, adjusted for covariates, were used to examine differences between cycles. RESULTS: The unadjusted prevalence of insomnia symptoms increased from 15.6% to 17.1% between 2002 and 2012, representing an absolute increase of 1.5%. The likelihood of insomnia symptoms was significantly influenced by age, sex, education, physical health, and mental health status. A 3-way year-age-sex interaction was statistically significant such that women aged 40-59 demonstrated approximately 29% increased likelihood of insomnia symptoms from 2002 to 2012. This was reduced to 24% when adjusted for physical and mental health. There were no significant differences for men across age groups. CONCLUSION: Over a 10-year period, the prevalence of insomnia symptoms increased in Canada. This trend appears to be driven in part by greater levels of insomnia symptoms among middle-aged women.

Qualitative Analysis of Infant Safe Sleep Public Campaign Messaging.

The 1994 Back to Sleep public education campaign resulted in dramatic reductions in sleep-related infant deaths, but comparable progress in recent years has been elusive. We conducted qualitative analyses of recent safe sleep campaigns from 13 U.S. cities. Goals were to (a) determine whether the campaigns reflect the full range of American Academy of Pediatrics (AAP) 2011 safe sleep recommendations, (b) describe tone and framing of the messages (e.g., use of fear appeals), (c) describe targeting/tailoring of messages to priority populations, and (d) ascertain whether the campaigns have been evaluated for reach and/or effectiveness. Methods included computer-assisted analyses of campaign materials and key informant interviews. All campaigns included "ABC" (Alone, Back, Crib) messaging; many ignored other AAP recommendations such as breastfeeding, room-sharing, immunizations, and avoiding smoke exposure. Campaigns frequently targeted priority populations such as African Americans. Fear appeals were used in three quarters of the campaigns, and 60% of the fear-based campaigns used guilt/blame messaging. We did not find published evaluation data for any of the campaigns. More attention is needed in public education campaigns to the full range of AAP recommendations, and evaluations are needed to determine the impact of these interventions on knowledge, behavior, and health outcomes.

Serious Delinquency and Gang Participation: Combining and Specializing in Drug Selling, Theft and Violence.

Using Pittsburgh Youth Study data, we examined the extent to which over 600 gang members and non-gang involved young men specialized in drug selling, serious theft, or serious violence or engaged simultaneously in these serious delinquent behaviors, throughout the 1990s. We found that the increase in delinquency associated with gang membership was concentrated in two combinations: serious violence and drug selling; serious violence, drug selling, and serious theft. Several covariates were similarly associated with multi-type serious delinquency and gang membership (age, historical time, Black race, and residential mobility), suggesting that these behaviors may share common developmental, familial, and contextual risks. We encourage future research to further examine the association of gang membership with engagement in particular configurations of serious delinquency.

People awakening: collaborative research to develop cultural strategies for prevention in community intervention.

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup'ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science.

Infant, Control Thyself: Infants' Integration of Multiple Social Cues to Regulate Their Imitative Behavior.

This study investigated 15-month-old infants' (N = 150) ability to self-regulate based on observing a social interaction between two adults. Infants were bystanders to a social exchange in which an Experimenter performed actions on objects and an Emoter expressed anger, as if they were forbidden acts. Next, the Emoter became neutral and her visual access to the infant was experimentally manipulated. The Emoter either: (a) left the room, (b) turned her back, (c) faced the infant but looked down at a magazine, or (d) faced and looked toward the infant. Infants were then presented with the test objects. When the previously angry Emoter was facing them, infants were hesitant to imitate the demonstrated acts in comparison to the other conditions. We hypothesize that infants integrated the emotional and visual-perceptual cues to determine whether the Emoter would get angry at them, and then regulated their behavior accordingly. Temperament was related to infants' self-regulation -infants with higher impulsivity scores were more likely to perform the forbidden acts. Taken together, these findings provide insight into the roots of executive functions in late infancy.