Thesis (M.A.)--West Virginia University, 2002. / Title from document title page. Document formatted into pages; contains viii, 64 p. Includes abstract. Includes bibliographical references (p. 35-39).

Thesis (Ph. D.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains x, 113 p. : ill. Includes abstract. Includes bibliographical references (p. 66-73).

Introduction and Rationale: Sudden infant death syndrome (SIDS) continues to be the leading cause of death in infants 28 days to 12 months old and the third leading cause of infant mortality (CDC, 2014; Task Force on SIDS, 2011a). SIDS has no identifiable cause although many hypotheses have existed and there are many known risk factors. Nicotine use is the second most modifiable risk factor for SIDS and to date there is no national public education campaign. Formal education is needed. Written education materials, such as brochures, are an effective way to increase knowledge and awareness of a health topic. Purpose and Objective: The purpose of this DNP Project was to create an educational brochure about SIDS and nicotine as a significant modifiable risk factor. The brochure is directed towards pregnant women and women with infants less than 12 months of age. The objective was to educate and inform mothers about SIDS, nicotine and its relation to SIDS, and the importance of abstaining from nicotine during and after pregnancy. Methods: The brochure was created using the Health Belief Model (HBM) as a framework. The HBM was used to explain health behavior modifications and was used as a foundation for education interventions. The model has successfully been applied to explain other preventative health behaviors and provide health education in various contexts. Results: The brochure was evaluated by two subject matter experts who have published peer reviewed articles using the HBM. Both subject matter experts found the HBM applied to the brochure appropriately. In their opinion, the content of the brochure should have positive impact for health modification in women who use nicotine and are pregnant or have a child less than 12 months of age. Conclusions: This DNP Project demonstrated SIDS as a current significant health problem and identified maternal nicotine use as the second most modifiable risk factor. Due to lack of current public education, a brochure was created using the HBM as a framework. Subject matter experts stated the brochure was created based on the HBM and will likely a have positive health influence on the intended population.

Bakgrund: För föräldrarna till ett spädbarn har barnets sömn stor betydelse. BVC-sköterskan är den som främjar barns hälsa och ger föräldrastöd. Syfte: Syftet med den här studien var att beskriva BVC-sköterskors erfarenheter och redovisa reflektioner kring för­äldra­­­­stöd som rör sömnfrågor hos spädbarn upp till ett års ålder. Metod: Stud­ien hade en beskrivande design med en kvalitativ ansats och genomfördes via semi­struk­tur­erade intervjuer med åtta BVC-sköterskor inom BVC-verksamheter i en mellan­stor svensk kommun. Materialet har analyserats med kvalitativ innehållsanalys. Resu­ltat: Resultatet utgjordes av tre beskrivande kategorier. Kategorin ”Samtalar om barnet och hjälper för­äldrarna att se till barnets behov” beskriver hur BVC-sköterskorna kom­mun­icerar med föräldrarna om deras barn och vilka råd de ger för att förebygga prob­lem. Kate­gorin ”Ger föräldrarna strategier att klara sin nya livssituation” beskriver hur BVC- sköt­er­skorna bedömde föräldrarnas individuella behov av stöd i föräldra­skapet kring sömn­­­frågor och om BVC-sköterskornas beskrivning av råd de ger kring omgiv­nings­faktorer som kan underlätta. Kategorin ”Spädbarns sömnproblem är kom­plexa och det finns sällan en enkel lösning” beskriver hur BVC-sköterskorna arbetar med föräl­drastöd när de får kännedom om att ett spädbarn upplevs ha ett sömnproblem, vad de har för reflek­tioner runt det arbetet och vad de har erfarenhet av som kan ligga bakom sömn­problem. Slutsats: Slutsatsen är att BVC-sköterskorna gav råd om åt­gärder som förebyggde sömnproblem. Det var ofta samma typ av åtgärder som också kunde av­hjäl­pa sömn­problem. När barnen utvecklat större sömnproblem så krävdes det ofta mer struk­tur och konsekvens av föräldrarna. BVC-sköterskorna utgick från hela familjens situation när de stöttade föräldrar. / Background: For the parents of an infant the child's sleep is of great importance. The child health care nurse (CHCN) is the one who ensures children's health and provide parental support. Aim: The aim of this study was to describe the CHCN's experiences and reflections on parental support in sleep related issues in infants up to one year of age. Method: The present study had a descriptive design with a qualitative approach and was carried out through semi-structured interviews with eight nurses at child health care centers in a medium-sized Swedish municipality. The material was analyzed using qualitative content analysis. Result: The result consisted of three descriptive categories. The category "Talks about the infant and helps the parents to ensure the infant's needs," describes how the CHCN's communicate with parents about their children and what ad­vice they provide to prevent problems. The category "Gives parents strategies to cope with their new life situation" describes how CHCN's assessed the parents' individual needs for parental support around sleep issues and about the surrounding factors that can facilitate. The category "Infant sleep problems are complex and there is rarely a sim­­­­ple solution" describes how the CHCN's works with parental support when they gain knowledge that an infant is perceived to have a sleep problem, their reflections on the work and their experiences of sleep problems. Conclusion: The conclusion was that the CHCN's gave advice on measures that prevented sleep problems. It was often the same type of action that could also remedy sleep problems. When children develop greater sleep problems it often took more structure and consistency of the parents to manage it. CHCN's emanated from the whole family's situation when they supported parents.

Establishing healthy sleep-wake patterns early in infancy is vitally important as sleep problems can persist. Behavioural sleep interventions such as the parental presence procedure are well established and have been found to improve infant sleep as determined by parent report. The exact nature of this improvement is, however, unclear. Sleep consolidation, sleep-state organisation, and self-soothing are thought likely to change after intervention; however, no known research has comprehensively determined which of these variables change as infant sleep changes in response to intervention. Three participants aged between 7 to 11 months who met the criteria for Infant Sleep Disturbance (ISD) were referred by a Health Centre and the parental presence behavioural sleep intervention was implemented. Parental report and videosomonography (VSG) data were used to measure sleep before and after intervention. While parental report is limited in that parents can only report what they can hear and/or see, VSG offers a tool that can be used to measure sleep-state organisation, state changes, and periods when the infant is awake and quiet. The present research found that infants’ sleep became more consolidated resulting in fewer sleep-wake transitions and night wakings. Infants who had difficulties initiating sleep on their own also demonstrated decrease in Sleep Onset Delay (SOD). Furthermore, infants were found to sleep through a greater number of sleep-state transitions and sleep for a greater duration of time before waking. Collectively this research provides some evidence that changing parental behaviours to those that promote self-initiation through self-soothing and consistency, can change sleep-state organisation and improve self-soothing.

Thesis (Ph.D.)--University of Tennessee Health Science Center, 2008 / Title from title page screen (viewed on June 19, 2008). Research advisor: Pamela S. Hinds RN, Ph.D. Document formatted into pages (viii, 185 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 86-98).

<b>Introduction</b>: Maternal antenatal depression has been associated with an increased risk of offspring psychopathology and more recently with disturbed infant sleep; in particular, shorter sleep duration, more awakenings and sleep problems. The exact mechanisms through which risk may be transmitted remain unknown, as does the question of whether all infants are equally susceptible to the effects of antenatal depression. The primary objectives of this thesis were to examine: i) The role of two potential moderators on the association between antenatal depression and infant sleep: infant reactive temperament and the serotonin transporter polymorphism 5-HTTLPR ii) The association between antenatal depression and infant sleep using objective behavioural and physiological measures. iii) Infant sleep and temperament in a pilot randomised controlled trial (RCT) following treatment of antenatal depression <b>Methods</b> i) The role of infant reactivity and 5-HTTLPR as potential moderators was examined in two large longitudinal cohorts: the Avon Longitudinal Study of Parents And Children (ALSPAC) and the Generation R study, based in the UK and The Netherlands respectively (n=8,991 and n=2,441). ii) An Oxford based pilot longitudinal family study (n=16) iii) A pilot randomised controlled trial of women with antenatal depression who received Cognitive Behavioural Therapy (CBT) or Care as Usual (n=25). <b>Results</b> i) There was evidence that reactive temperament moderated the association between antenatal depression and infant sleep; boys seemed to be most affected exhibiting more awakenings, sleep problems and shorter sleep duration. 5-HTTLPR did not moderate this association. ii) Antenatal depression was associated with shorter infant sleep duration 5 months postpartum iii) Improvement in depression was associated with shorter infant sleep duration and easier temperament 2 months postpartum <b>Conclusion</b>: This thesis suggests that not all infants are equally susceptible to environmental influences and this may prove important in targeting interventions. The role of genetic factors in conferring any susceptibility remains unclear. Actigraphy offering accurate representation of activity levels and timing during the day and night was a significant methodological advantage, but recruitment to a study incorporating these proved challenging. Finally, psychological interventions during pregnancy appear to have beneficial effects for child development.

Essa tese aborda dois tópicos pouco explorados na literatura científica brasileira: a síndrome da morte súbita do lactente (SMSL) e o coleito. O objetivo principal foi avaliar o impacto de uma intervenção educativa individual para mães na maternidade, em relação ao posicionamento para dormir da criança. Secundariamente, verificou-se a prevalência de coleito e os fatores associados a esse arranjo para dormir. Realizou-se um ensaio clínico randomizado com 228 duplas de mães e seus filhos. A intervenção consistia em uma sessão individual de orientação na maternidade sobre a importância da posição supina para a criança dormir na prevenção da SMSL. O desfecho principal foi a posição de dormir da criança aos três e seis meses de idade, registrada durante visitas domiciliares. Regressão de Poisson foi utilizada para identificar os fatores associados ao coleito. Em relação ao posicionamento de dormir da criança, conforme relatado pela mãe. 42,9% das mães do grupo intervenção e 24,0% das mães do grupo controle colocavam seus filhos para dormir na posição supina na visita aos três meses (p= 0,009). A intervenção no hospital foi a única variável que influenciou as práticas maternas em relação à posição de dormir da criança (RC= 1,35; IC 95% = 1,08 - 1,64). A prevalência de coleito aos três e seis meses foi de, respectivamente, 31,2% e 28,5%. Aos três meses, o coleito estava associado a mãe sem companheiro (RP= 1,56; IC= 1,01-2,39) e a coabitação com a avó materna da criança (RP= 1,70; IC= 1,09-1,65). Concluindo, uma sessão educativa individual na maternidade aumentou significativamente a prevalência da posição supina para dormir no terceiro mês de vida da criança, mas não foi suficiente para garantir que a maioria das mães colocasse seus filhos para dormir nessa posição. Quanto ao coleito, ele se mostrou comum nos primeiros seis meses, estando associado à mãe sem companheiro e a coabitação com a avó materna da criança. / This study addresses two that issues have been little studied in the Brazilian scientific literature: sudden infant death syndrome (SIDS) and bedsharing. The main objective of this study was to evaluate the impact of an individual educational intervention given to mothers in the maternity ward regarding the infant sleep position. Secondarily we verified the prevalence of bedsharing and the variables associated to with this sleep arrangement. A randomized clinical trial was performed, in which 228 pairs of mothers-infants were included. The intervention consisted in an individual educational session for mothers in the maternity ward, concerning the recommendation of the supine position for infant sleep to prevent SIDS. The main outcome was the position in which the infant slept at night at three and six months, registered during home visits. The Poisson regression was applied to identify the factors associated with bedsharing. Regarding the infant sleep position, according to mothers' report, 42.9 percent of the mothers in the intervention group and 24.0 percent of the control group put their infants to sleep in the supine position at three months' visit (p= 0.009). The intervention in the hospital was the only variable that influenced maternal practices concerning the infant sleep position (OR= 1.33; CI 95% = 1.08 - 1.64). The prevalence of bedsharing at three and six months was, respectively, 31.2 and 28.5 percent. At three months bedsharing was associated to mother without partner (prevalence ratio [PR] 1.56; CI 1.01-2.39) and mother sharing the home with infant's maternal grandmother (PR= 1.70; CI= 1.09 - 1.65). We conclude that an individual educational session in the maternity ward significantly increased the prevalence of the infant's supine sleep position at three months. However, the intervention was not sufficient to assure the majority of the mothers would put their infants to sleep at this position. Bedsharing was common at the first six months of life and was associated with single mothers and sharing the home with infant's maternal grandmother.

Essa tese aborda dois tópicos pouco explorados na literatura científica brasileira: a síndrome da morte súbita do lactente (SMSL) e o coleito. O objetivo principal foi avaliar o impacto de uma intervenção educativa individual para mães na maternidade, em relação ao posicionamento para dormir da criança. Secundariamente, verificou-se a prevalência de coleito e os fatores associados a esse arranjo para dormir. Realizou-se um ensaio clínico randomizado com 228 duplas de mães e seus filhos. A intervenção consistia em uma sessão individual de orientação na maternidade sobre a importância da posição supina para a criança dormir na prevenção da SMSL. O desfecho principal foi a posição de dormir da criança aos três e seis meses de idade, registrada durante visitas domiciliares. Regressão de Poisson foi utilizada para identificar os fatores associados ao coleito. Em relação ao posicionamento de dormir da criança, conforme relatado pela mãe. 42,9% das mães do grupo intervenção e 24,0% das mães do grupo controle colocavam seus filhos para dormir na posição supina na visita aos três meses (p= 0,009). A intervenção no hospital foi a única variável que influenciou as práticas maternas em relação à posição de dormir da criança (RC= 1,35; IC 95% = 1,08 - 1,64). A prevalência de coleito aos três e seis meses foi de, respectivamente, 31,2% e 28,5%. Aos três meses, o coleito estava associado a mãe sem companheiro (RP= 1,56; IC= 1,01-2,39) e a coabitação com a avó materna da criança (RP= 1,70; IC= 1,09-1,65). Concluindo, uma sessão educativa individual na maternidade aumentou significativamente a prevalência da posição supina para dormir no terceiro mês de vida da criança, mas não foi suficiente para garantir que a maioria das mães colocasse seus filhos para dormir nessa posição. Quanto ao coleito, ele se mostrou comum nos primeiros seis meses, estando associado à mãe sem companheiro e a coabitação com a avó materna da criança. / This study addresses two that issues have been little studied in the Brazilian scientific literature: sudden infant death syndrome (SIDS) and bedsharing. The main objective of this study was to evaluate the impact of an individual educational intervention given to mothers in the maternity ward regarding the infant sleep position. Secondarily we verified the prevalence of bedsharing and the variables associated to with this sleep arrangement. A randomized clinical trial was performed, in which 228 pairs of mothers-infants were included. The intervention consisted in an individual educational session for mothers in the maternity ward, concerning the recommendation of the supine position for infant sleep to prevent SIDS. The main outcome was the position in which the infant slept at night at three and six months, registered during home visits. The Poisson regression was applied to identify the factors associated with bedsharing. Regarding the infant sleep position, according to mothers' report, 42.9 percent of the mothers in the intervention group and 24.0 percent of the control group put their infants to sleep in the supine position at three months' visit (p= 0.009). The intervention in the hospital was the only variable that influenced maternal practices concerning the infant sleep position (OR= 1.33; CI 95% = 1.08 - 1.64). The prevalence of bedsharing at three and six months was, respectively, 31.2 and 28.5 percent. At three months bedsharing was associated to mother without partner (prevalence ratio [PR] 1.56; CI 1.01-2.39) and mother sharing the home with infant's maternal grandmother (PR= 1.70; CI= 1.09 - 1.65). We conclude that an individual educational session in the maternity ward significantly increased the prevalence of the infant's supine sleep position at three months. However, the intervention was not sufficient to assure the majority of the mothers would put their infants to sleep at this position. Bedsharing was common at the first six months of life and was associated with single mothers and sharing the home with infant's maternal grandmother.

Essa tese aborda dois tópicos pouco explorados na literatura científica brasileira: a síndrome da morte súbita do lactente (SMSL) e o coleito. O objetivo principal foi avaliar o impacto de uma intervenção educativa individual para mães na maternidade, em relação ao posicionamento para dormir da criança. Secundariamente, verificou-se a prevalência de coleito e os fatores associados a esse arranjo para dormir. Realizou-se um ensaio clínico randomizado com 228 duplas de mães e seus filhos. A intervenção consistia em uma sessão individual de orientação na maternidade sobre a importância da posição supina para a criança dormir na prevenção da SMSL. O desfecho principal foi a posição de dormir da criança aos três e seis meses de idade, registrada durante visitas domiciliares. Regressão de Poisson foi utilizada para identificar os fatores associados ao coleito. Em relação ao posicionamento de dormir da criança, conforme relatado pela mãe. 42,9% das mães do grupo intervenção e 24,0% das mães do grupo controle colocavam seus filhos para dormir na posição supina na visita aos três meses (p= 0,009). A intervenção no hospital foi a única variável que influenciou as práticas maternas em relação à posição de dormir da criança (RC= 1,35; IC 95% = 1,08 - 1,64). A prevalência de coleito aos três e seis meses foi de, respectivamente, 31,2% e 28,5%. Aos três meses, o coleito estava associado a mãe sem companheiro (RP= 1,56; IC= 1,01-2,39) e a coabitação com a avó materna da criança (RP= 1,70; IC= 1,09-1,65). Concluindo, uma sessão educativa individual na maternidade aumentou significativamente a prevalência da posição supina para dormir no terceiro mês de vida da criança, mas não foi suficiente para garantir que a maioria das mães colocasse seus filhos para dormir nessa posição. Quanto ao coleito, ele se mostrou comum nos primeiros seis meses, estando associado à mãe sem companheiro e a coabitação com a avó materna da criança. / This study addresses two that issues have been little studied in the Brazilian scientific literature: sudden infant death syndrome (SIDS) and bedsharing. The main objective of this study was to evaluate the impact of an individual educational intervention given to mothers in the maternity ward regarding the infant sleep position. Secondarily we verified the prevalence of bedsharing and the variables associated to with this sleep arrangement. A randomized clinical trial was performed, in which 228 pairs of mothers-infants were included. The intervention consisted in an individual educational session for mothers in the maternity ward, concerning the recommendation of the supine position for infant sleep to prevent SIDS. The main outcome was the position in which the infant slept at night at three and six months, registered during home visits. The Poisson regression was applied to identify the factors associated with bedsharing. Regarding the infant sleep position, according to mothers' report, 42.9 percent of the mothers in the intervention group and 24.0 percent of the control group put their infants to sleep in the supine position at three months' visit (p= 0.009). The intervention in the hospital was the only variable that influenced maternal practices concerning the infant sleep position (OR= 1.33; CI 95% = 1.08 - 1.64). The prevalence of bedsharing at three and six months was, respectively, 31.2 and 28.5 percent. At three months bedsharing was associated to mother without partner (prevalence ratio [PR] 1.56; CI 1.01-2.39) and mother sharing the home with infant's maternal grandmother (PR= 1.70; CI= 1.09 - 1.65). We conclude that an individual educational session in the maternity ward significantly increased the prevalence of the infant's supine sleep position at three months. However, the intervention was not sufficient to assure the majority of the mothers would put their infants to sleep at this position. Bedsharing was common at the first six months of life and was associated with single mothers and sharing the home with infant's maternal grandmother.