Nighttime breastfeeding behavior is associated with more nocturnal sleep among first-time mothers at one month postpartum

STUDY OBJECTIVE

To describe sleep duration and quality in the first month postpartum and compare the sleep of women who exclusively breastfed at night to those who used formula.

METHODS

We conducted a longitudinal study in a predominantly low-income and ethnically diverse sample of 120 first-time mothers. Both objective and subjective measures of sleep were obtained using actigraphy, diary, and self-report data. Measures were collected in the last month of pregnancy and at one month postpartum. Infant feeding diaries were used to group mothers by nighttime breastfeeding behavior.

RESULTS

Mothers who used at least some formula at night (n = 54) and those who breastfed exclusively (n = 66) had similar sleep patterns in late pregnancy. However, there was a significant group difference in nocturnal sleep at one month postpartum as measured by actigraphy. Total nighttime sleep was 386 ± 66 minutes for the exclusive breastfeeding group and 356 ± 67 minutes for the formula group. The groups did not differ with respect to daytime sleep, wake after sleep onset (sleep fragmentation), or subjective sleep disturbance at one month postpartum.

CONCLUSION

Women who breastfed exclusively averaged 30 minutes more nocturnal sleep than women who used formula at night, but measures of sleep fragmentation did not differ. New mothers should be encouraged to breastfeed exclusively since breastfeeding may promote sleep during postpartum recovery. Further research is needed to better understand how infant feeding method affects maternal sleep duration and fragmentation.

CITATION

Doan T; Gay CL; Kennedy HP; Newman J; Lee KA. Nighttime breastfeeding behavior is associated with more nocturnal sleep among first-time mothers at one month postpartum.

Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding

AIM

The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB), which was developed and validated in the USA. We assessed the BLEED criteria in a UK population and aimed to elucidate factors that can be implemented for early risk stratification.

METHOD

Patients were identified from a prospectively maintained surgical admission database at a central London teaching hospital. Data were collected on 26 clinical factors available on initial presentation. The primary-outcome end-points included severe bleeding (persistent bleeding within the first 24 h, blood transfusion, a decrease in haematocrit of ≥ 20% or recurrent bleeding after ≥ 24 hours of stability) and adverse outcome (emergency surgery to control bleeding, intensive care unit [ITU] admission or death).

RESULTS

One hundred and eighty-four clinical episodes were identified, representing 3% of all surgical referrals. Twelve patients with upper gastrointestinal bleeding were excluded. Severe bleeding occurred in 110 (64%) patients. An adverse outcome was recorded in 20 (11.6%) patients, and 10 (5.4%) patients died during admission. The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine > 150 μm (P = 0.002); age > 60 years (P = 0.001); abnormal haemodynamic parameters on presentation (P = 0.05); persistent bleeding within the first 24 h (P = 0.05); and area under the receiver-operating characteristics curve (AUC) = 0.79. The BLEED criteria were shown to be nonpredictive (AUC = 0.60).

CONCLUSION

The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors that could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate the early identification of patients requiring more aggressive resuscitation, admission to a monitored bed and consideration for early radiological or surgical intervention.

Comparison of myocardial ischemia during intense mental stress using flight simulation in airline pilots with coronary artery disease to that produced with conventional mental and treadmill exercise stress testing

Mental stress increases cardiovascular morbidity and mortality. Although laboratory mental stress often causes less myocardial ischemia than exercise stress (ES), it is unclear whether mental stress is intrinsically different or differences are due to less hemodynamic stress with mental stress. We sought to evaluate the hemodynamic and ischemic response to intense realistic mental stress created by modern flight simulators and compare this response to that of exercise treadmill testing and conventional laboratory mental stress (CMS) testing in pilots with coronary disease. Sixteen airline pilots with angiographically documented coronary disease and documented myocardial ischemia during ES were studied using maximal treadmill ES, CMS, and aviation mental stress (AMS) testing. AMS testing was done in a sophisticated simulator using multiple system failures as stressors. Treadmill ES testing resulted in the highest heart rate, but AMS caused a higher blood pressure response than CMS. Maximal rate-pressure product was not significantly different between ES and AMS (25,646 vs 23,347, p = 0.08), although these were higher than CMS (16,336, p <0.0001). Despite similar hemodynamic stress induced by ES and AMS, AMS resulted in significantly less ST-segment depression and nuclear ischemia than ES. Differences in induction of ischemia by mental stress compared to ES do not appear to be due to the creation of less hemodynamic stress. In conclusion, even with equivalent hemodynamic stress, intense realistic mental stress induced by flight simulators results in significantly less myocardial ischemia than ES as measured by ST-segment depression and nuclear ischemia.

Modeling distribution and abundance of soybean aphid in soybean fields using measurements from the surrounding landscape

Soybean aphid (Aphis glycines Matsumura) is a severe pest of soybean in central North America. Outbreaks of the aphid in Ontario are often spotty in distribution, with some geographical areas affected severely and others with few or no aphid populations occurring in soybean for the duration of the season. A. glycines spend summers on soybean and overwinter on buckthorn, a shrub that is widespread in southern Ontario and is commonly found in agricultural hedgerows and at the margins of woodlots. A. glycines likely use both short distance migratory flights from buckthorn and longer distance dispersal flights in the search for acceptable summer hosts. This study aims to model colonization of soybean fields by A. glycines engaged in early-season migration from overwintering hosts. Akaike's information criterion (AIC) was used to rank numerous competing linear and probit models using field parameters to predict aphid presence, colonization, and density. The variable that best modeled aphid density in soybean fields in the early season was the ratio of buckthorn density to field area, although dramatic differences in relationships between the parameters were observed between study years. This study has important applications in predicting areas that are at elevated risk of developing economically damaging populations of soybean aphid and which may act as sources for further infestation.