Adequate sleep duration in childhood has important implications for social, mental, and physical well-being. Recent evidence has demonstrated declining sleep durations in children; therefore effective interventions to improve sleep measures are needed. Despite some trials suggesting that multi-behavioural interventions promoting bed-time routines may be beneficial, the effectiveness of such interventions has not been adequately quantified. Moreover, specific themes and strategies which increase sleep duration, and by how much, have not been formally quantified.
Methods
We carried out a systematic review and meta-analysis to quantify the effectiveness of sleep interventions to improve sleep duration in children within community settings (PROSPERO ID CRD42019160089). Studies involving infants under 1 year, those using medications, and targeting children with behavioural problems were excluded. We screened 11621 randomised control trials (RCT), after carrying out a search using combined text words and MeSH criteria in CENTRAL, MEDLINE, EMBASE, PSYCHINFO, Web of science, clinicaltrials.gov, and WHO trials databases. Full text screening of 341 studies identified 39 studies for data extraction. All screening was carried out independently by two reviewers using a web-based platform for systematic reviews.
Results
Studies were categorised by age as follows: 20% in >1–5 years of age, 25% >5–10 years, 33% >10–15 years, 22% >15 years. The mode of delivery of most interventions was face to face (74%). The intervention setting was most commonly school based (54%), with 21% based at home. Intervention duration was less than one month in 49% of studies. Qualitative data to describe each intervention was collected using a framework based on the TIDieR checklist. We are mapping this onto behavioural frameworks (COM-B, theoretical domains framework), to categorise interventions. Our initial analysis, from 9911 participants (4719, intervention, 5192 control) from 33 studies, suggests that mean differences in interventions increase sleep duration by 11 minutes (95% CI 6, 17 mins). However, caution is needed in interpreting this overall effect size (pooled using random effects) given the considerable heterogeneity across studies (I2 = 91%). The influence of study design characteristics in explaining heterogeneity (including age of participants, duration and type of intervention) will be outlined.
Conclusion
This review furthers our understanding of the most effective interventions to improve sleep duration in children and provides a platform to develop population level health interventions to improve sleep. Given challenges assimilating data, an overarching aim is to develop approaches that could be used to homogenise reporting in future RCTs in order that evidence can be summarised more easily.
Large-scale electronic primary care datasets can provide up-to-date, accurate epidemiological information on rarer diseases. In the UK, approximately 70,000 people are estimated to be living with neuromuscular disease (NMD), but this approximation is over 10 years old and used historical estimates from different sources. While GPs are unlikely to make NMD diagnoses themselves, specialist diagnoses from hospital discharges and clinic letters are well recorded and electronically searchable within primary care records. The recent expansion of the Clinical Practice Research Datalink (CPRD) allows timely reporting on the recorded incidence and prevalence of NMD in the UK over the last 20 years.
Methods
A harmonised dataset of CPRD GOLD and Aurum was developed to provide annual denominators of actively registered patients between 2000 and 2019. A Read code hierarchy was developed for a wide range of NMDs; the database was then searched electronically to estimate incidence and (lifetime) prevalence rates in each year. To compare trends over time, rates were age standardised to the most recent CPRD population (2019).
Results
The combined CPRD database contained approximately 13 million patients actively registered in each year. By 2019, 28,230 active patients had ever received a Read code for one of the NMDs (223.6 per 100,000), which would scale up to approximately 149,000 people in the UK. Lifetime prevalence rates per 100,000 were higher among males (239.0) than females (208.3). The most common classifications were Guillain-Barre syndrome (40.1), myasthenia gravis (33.7), muscular dystrophy (29.5), Charcot-Marie-Tooth (29.5) and inflammatory myopathies (25.0). Since 2000, overall prevalence grew by 63% but incidence remained steady over time. All age groups showed an increase in prevalence, with the largest increases seen at older ages (≥65-years). Among individual conditions since about 2008, incidence of myasthenia gravis has been steadily rising while new cases of muscular dystrophy fell over the same period.
Conclusions
Lifetime recording of many NMDs on primary care records exceeds current estimates of people living with these conditions; these are important data for health service and care planning. Temporal trends suggest this number is steadily increasing and there may be twice as many people living with these conditions than currently thought. While this may be partially due to increases in recording, it cannot be simply explained by new cases as incidence is largely unchanged over time. The increase in prevalence among older ages suggest increases in life expectancy among those living with NMDs may have taken place.
### What you need to know
Rollout of covid-19 vaccination is well underway, with more than 700 million doses given worldwide as of April 2021.1 Vaccination is highly effective at reducing severe illness and death from covid-19. Vaccines for covid-19 are also safe, with extremely low risks of severe adverse events.234 A major threat to the impact of vaccination in preventing disease and death from covid-19 is low uptake of vaccines. In this practice pointer we offer on overview of vaccine hesitancy and some approaches that clinicians and policymakers can adopt at the individual and community levels to help people make informed decisions about covid-19 vaccination.
The World Health Organization defines vaccine hesitancy as a “delay in acceptance or refusal of safe vaccines despite availability of vaccine services.”5 It is caused by complex, context specific factors that vary across time, place, and different vaccines, and is influenced by issues such as complacency, convenience, confidence, and sociodemographic contexts.6 Vaccine hesitancy may also be related to misinformation and conspiracy theories which are often spread online, including through social media.78 In addition, structural factors such as health inequalities, socioeconomic disadvantages, systemic racism, and barriers to access are key drivers of …
Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) have been widely proposed as in vitro models of myocardial physiology and disease. A significant obstacle, however, is their immature phenotype. We hypothesised that Ca2+ cycling of iPSC-CM is influenced by culture conditions and can be manipulated to obtain a more mature cellular behaviour. To test this hypothesis we seeded iPSC-CM onto fibronectin coated microgrooved polydimethylsiloxane (PDMS) scaffolds fabricated using photolithography, or onto unstructured PDMS membrane. After two weeks in culture, the structure and function of iPSC-CM were studied. PDMS microgrooved culture substrates brought about cellular alignment (p < 0.0001) and more organised sarcomere. The Ca2+ cycling properties of iPSC-CM cultured on these substrates were significantly altered with a shorter time to peak amplitude (p = 0.0002 at 1 Hz), and more organised sarcoplasmic reticulum (SR) Ca2+ release in response to caffeine (p < 0.0001), suggesting improved SR Ca2+ cycling. These changes were not associated with modifications in gene expression. Whilst structured tissue culture may make iPSC-CM more representative of adult myocardium, further construct development and characterisation is required to optimise iPSC-CM as a model of adult myocardium.
<p> </p> <h3>Objective</h3> <p>People living with type 2 diabetes (T2DM) are at higher infection risk, but it is unknown how this risk varies by ethnicity, or whether the risk is similarly observed in people with non-diabetic hyperglycaemia (“prediabetes”).</p> <h3>Research Design and Methods</h3> <p>We included 527,151 patients in England with T2DM and 273,216 with prediabetes, aged 18-90 and alive on 1st January 2015 on the Clinical Practice Research Datalink. Each were matched to 2 patients without diabetes or prediabetes on age, sex and ethnic group. Infections during 2015-9 were collated from primary care and linked hospitalisation records. Infection incidence rate ratios (IRR) for prediabetes or T2DM were estimated, unadjusted and adjusted for confounders.</p> <h3>Results</h3> <p>People with T2DM had increased risk for infections presenting in primary care (IRR=1.51, 95%CI 1.51-1.52) and hospitalisations (IRR=1.91, 1.90-1.93). This was broadly consistent overall within each ethnic group, though younger White T2DM patients (age <50) experienced a greater relative risk. Adjustment for socio-economic deprivation, smoking and co-morbidity attenuated associations, but IRRs remained similar by ethnicity. For prediabetes, a significant but smaller risk was observed (primary care IRR=1.35 1.34-1.36, hospitalisation IRR=1.33, 1.31-1.35); these were similar within each ethnicity for primary care infections, but less consistent for infection related hospitalisations.</p> <h3>Conclusions</h3> <p>The elevated infection risk for people with T2DM appears similar for different ethnic groups and is also seen in people with prediabetes. Infections are a substantial cause of ill-health and health service use for people with prediabetes and T2DM. This has public health implications with rising prediabetes and diabetes prevalence. </p>
In the UK, large-scale electronic primary care datasets can provide up-to-date, accurate epidemiological information on rarer diseases, where specialist diagnoses from hospital discharges and clinic letters are generally well recorded and electronically searchable. Current estimates of the number of people living with neuromuscular disease (NMD) have largely been based on secondary care data sources and lacked direct denominators.To estimate trends in the recording of neuromuscular disease in UK primary care between 2000-2019.The Clinical Practice Research Datalink (CPRD) database was searched electronically to estimate incidence and prevalence rates (per 100,000) for a range of NMDs in each year. To compare trends over time, rates were age standardised to the most recent CPRD population (2019).Approximately 13 million patients were actively registered in each year. By 2019, 28,230 active patients had ever received a NMD diagnosis (223.6), which was higher among males (239.0) than females (208.3). The most common classifications were Guillain-Barre syndrome (40.1), myasthenia gravis (33.7), muscular dystrophy (29.5), Charcot-Marie-Tooth (29.5) and inflammatory myopathies (25.0). Since 2000, overall prevalence grew by 63%, with the largest increases seen at older ages (≥65-years). However, overall incidence remained constant, though myasthenia gravis incidence has risen steadily since 2008, while new cases of muscular dystrophy fell over the same period.Lifetime recording of many NMDs on primary care records exceed current estimates of people living with these conditions; these are important data for health service and care planning. Temporal trends suggest this number is steadily increasing, and while this may partially be due to better recording, it cannot be simply explained by new cases, as incidence remained constant. The increase in prevalence among older ages suggests increases in life expectancy among those living with NMDs may have occurred.
Adequate sleep duration is necessary for many aspects of child health, development, and well-being, yet sleep durations for children are declining, and effective strategies to increase sleep in healthy children remain to be elucidated.To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions.CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021.Randomized clinical trials of interventions to improve sleep duration in healthy children were independently screened by 2 researchers. A total of 28 478 studies were identified.Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Random-effects meta-analytic models were used to estimate pooled effect sizes.Difference in sleep duration, measured in minutes.A total of 13 539 child participants from 45 randomized clinical trials were included. Of these, 6897 (50.9%) were in the intervention group and 6642 (49.1%) in the control group, and the mean age ranged from 18 months to 19 years. Pooled results indicate that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4) longer nocturnal sleep duration. There was substantial variation between trials. Sources of variation that were not associated with the study effect size included age group, whether the population was identified as having a sleep problem or being at a socioeconomic disadvantage (eg, coming from a low-income family or area), method of assessment of sleep duration (objective vs subjective), location of intervention delivery (home vs school), whether interventions were delivered in person or used parental involvement, whether behavioral theory was used, environmental change, or had greater or lower intensity. Interventions that included earlier bedtimes were associated with a 47-minute sleep extension (95% CI, 18.9-75.0; 3 trials) compared with remaining studies (7.4 minutes; 95% CI, 2.9-11.8; 42 trials) (P = .006 for group difference). Trials of shorter duration (6 months or less) had larger effects.Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.
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