• Sexton Reed posted an update 6 months, 3 weeks ago

    Study objectives This study aimed to evaluate the effect of weighted chain blankets on insomnia and sleep-related daytime symptoms for patients with major depressive disorder, bipolar disorder, generalized anxiety disorder (GAD) and attention deficit hyperactivity disorder (ADHD). Methods One hundred twenty patients were randomized (11) to either a weighted metal chain blanket or a light plastic chain blanket for four weeks. The outcome was evaluated using the Insomnia Severity Index (ISI) as primary outcome measure and the Day and Night Diaries (DND), Fatigue Symptom Inventory (FSI), and Hospital Anxiety and Depression Scale (HADS) as secondary outcome measures. Sleep and daytime activity levels were evaluated by wrist actigraphy. Results At four weeks, there was a significant advantage in ISI-ratings of the weighted blanket intervention over the light blanket (p less then 0.001) with a large effect size (Cohen´s d 1.90). The intervention by the weighted blanket resulted in a significantly better sleep-maintenance, a higher daytime activity level and reduced daytime symptoms of fatigue, depression and anxiety. No serious adverse events occurred. During a 12 months open follow up phase of the study, participants continuing using weighted blankets maintained the effect on sleep, while patients switching from a light to a weighted blanket got a similar effect on ISI-ratings as participants using the weighted blanket from the beginning. Conclusions We conclude that weighted chain blankets are an effective and safe intervention for insomnia in patients with Major depressive disorder, Bipolar disorder, Generalized Anxiety Disorder, or ADHD, also improving daytime symptoms and levels of activity.Study objectives To systematically survey the scientific literature concerning the effect of playing a wind instrument or singing on sleep, snoring, and/or OSA. Methods The PubMed, EMBASE, and Cochrane databases were searched up to December 2019. Observational studies and (R)CCTs that assessed sleep, snoring, or OSA as clinical outcome or via a questionnaire were included. For the individual studies, the potential risk of bias was scored. Data between oral musicians and controls was extracted. Descriptive analysis as well as meta-analysis were performed. Results Six eligible studies (5 cross-sectional, 1 RCT) were retrieved, with an estimated potential bias ranking from low to high. The sample sizes ranged from 25 to 1105 participants. Descriptive analysis indicated that players of a double-reed instrument have a lower risk of OSA, and that singers snore less as compared to controls. Playing a didgeridoo showed a positive effect on AHI, daytime sleepiness and partner’s rating for sleep disturbance. The descriptive analysis could not be substantiated in the meta-analysis. The magnitude of the effect was zero to small and the generalizability was limited because of long (professional) rehearsal time or small sample size. Conclusions Playing a wind instrument and singing may have a small but positive effect on sleep disorders. Taking into account the practicality and investment of (rehearsal) time, didgeridoo and singing are the most promising interventions to reduce OSA and snoring, respectively. However, the results of this review are based on few studies and the synthesis of the evidence is graded to have low certainty.Study objectives The aim of this review is to summarize the existing literature on the association between sleep problems and cognition, function and behavior in children with Down syndrome. Methods Embase, PubMed, CINHAL and PsychINFO databases were searched to retrieve all studies published between 1990-2018 that evaluated the relationship between sleep and cognition, function or behavior in children with Down syndrome. Results Fifteen articles were included, which were mostly cohort or case-controlled design. Five articles addressed sleep and cognition only, Six sleep and behavior and only one sleep and functional ability. Three papers evaluated sleep and both cognition and behavior. Findings varied across studies with methodological differences making it difficult to directly compare results. The association between sleep and behavior or cognition in children with Down syndrome remains uncertain but a large study of 110 children provides strong evidence of a negative impact of sleep disorders on the accomplishment of daily life habits. Conclusions The impact of co-existing sleep disorders in children with Down syndrome has not been widely studied, with only fifteen relevant studies found through an extensive literature review. Large well-designed studies are required to fully understand this relationship further. This is important as sleep disordered breathing and difficulties with sleep patterns and routines are highly prevalent in children with Down syndrome. Sleep may be one of the few treatable factors that can assist in improving long-term outcomes in this population.Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. 680C91 purchase Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.

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