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Douglas PS. The need to acknowledge similarities between the 2022 D'Souza and Cassels and the 2014 Whittingham and Douglas contextual models of infant sleep. Sleep Health 2023; 9:797-800. [PMID: 37770249 DOI: 10.1016/j.sleh.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Pamela Sylvia Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
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Hall K, Patel R, Evans J, Greenwood R, Hicks J. The relationship between perinatal circadian rhythm and postnatal depression: an overview, hypothesis, and recommendations for practice. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AbstractPostnatal depression (PND) is an important public health problem with far-reaching consequences for mothers, families, and society. Current treatment approaches tend to focus on the depressive symptoms of the mother. We propose the need for a shift in the conceptualisation of PND and its management, by focusing on circadian rhythm as an early manifestation of mother-infant synchrony. We have reviewed the relevant interdisciplinary literature to formulate a hypothesis and suggest recommendations for practice. We hypothesise that, after a mother’s circadian rhythm becomes ‘desynchronised’ immediately following birth, persistence of this disruption is implicated in the development of PND. This has important implications for novel treatment strategies in the critical and vulnerable postnatal period, for example the use of outdoor-based interventions and light.
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Hendy A, Alsharkawy SS, El-Nagger NS. The outcomes of a healing environment and clustering nursing care on premature infants' vital signs, pain, and sleeping. J Med Life 2022; 15:1347-1351. [PMID: 36567831 PMCID: PMC9762362 DOI: 10.25122/jml-2022-0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022] Open
Abstract
Our study aimed to assess the effects of creating a healing environment and clustering nursing care on premature infants' vital signs, pain, and sleeping. The study had an experimental research design for the control and study group, each with 53 premature infants. We collected the data through the Vital Signs Sheet, Premature Infant Pain Profile, and Neonatal behavioral state. We used T-tests and chi-square tests to assess the differences between groups. There was a highly statistically significant difference between the study and control groups concerning respiration (p-value<0.01) and heart rate, systolic blood pressure, and O2 saturation (p-value<0.05). 90.6% of participants in the study group had a mild total premature infant pain profile, while 37.7% of the control group had a moderate total premature infant pain profile score. Applying a healing environment and clustering nursing care significantly improved respiration, heart rate, oxygen saturation, and systolic blood pressure. Furthermore, it increased sleep time and decreased wake state and pain score.
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Affiliation(s)
- Abdelaziz Hendy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt,Corresponding Author: Abdelaziz Hendy, Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt. E-mail:
| | - Sabah Saad Alsharkawy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt,Faculty of Nursing, October University, Giza, Egypt
| | - Nahed Saied El-Nagger
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
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Boran P, Ergin A, Us MC, Dinleyici M, Velipaşaoğlu S, Yalçın SS, Barutçu A, Gökçay G, Gür E, Çamurdan Duyan A, Aydın A, Celep G, Almış H, Savcı G, Kondolot M, Nalbantoğlu B, Ünver Korgalı E, Yendur Ö, Orhon Şimşek F, Kara Uzun A, Bağ Ö, Koç F, Bülbül S. Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample. J Sleep Res 2022; 31:e13684. [PMID: 35790464 DOI: 10.1111/jsr.13684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.
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Affiliation(s)
- Perran Boran
- Department of Social Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey.,Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey
| | - Ahmet Ergin
- Division of Social Pediatrics, Department of Public Health and Department of Pediatrics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Mahmut Caner Us
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey
| | - Meltem Dinleyici
- Department of Social Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sevtap Velipaşaoğlu
- Department of Social Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Adnan Barutçu
- Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gülbin Gökçay
- Department of Social Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Emel Gür
- Department of Social Pediatrics, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Aysu Çamurdan Duyan
- Department of Social Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Adem Aydın
- Department of Social Pediatrics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Gökce Celep
- Department of Pediatrics, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Habip Almış
- Department of Pediatrics, Adiyaman University School of Medicine, Adiyaman, Turkey
| | | | - Meda Kondolot
- Department of Pediatrics, Social Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Burçin Nalbantoğlu
- Department of Pediatrics, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Elif Ünver Korgalı
- Departments of Pediatrics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Özge Yendur
- Department of Pediatrics, Kafkas University School of Medicine, Kars, Turkey
| | - Filiz Orhon Şimşek
- Department of Social Pediatrics, School of Medicine, Ankara University, Ankara, Turkey
| | - Aysun Kara Uzun
- Ankara Children's Hematology Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Özlem Bağ
- İzmir Dr. Behçet Uz Child Hospital, İzmir, Turkey
| | - Feyza Koç
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Selda Bülbül
- Department of Pediatrics, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Perrella SL, Miraudo J, Rea A, Geddes DT, Prosser SA. Maternal Evaluation of a Team-Based Maternity Care Model for Women of Low Obstetric Risk. J Patient Exp 2022; 9:23743735221092606. [PMID: 35434293 PMCID: PMC9006366 DOI: 10.1177/23743735221092606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In response to the need for affordable and comprehensive maternity care, a multidisciplinary team-based maternity care service led by general practitioners with obstetric training (GPOs) and midwives was established for women of low obstetric risk. We evaluated maternal satisfaction with this model of care. All women that attended the service and gave birth in 2020 were approached. Participants used an online survey to rate their satisfaction with aspects of their pregnancy, hospital stay and postpartum care and were invited to provide additional written feedback. Fifty percent (81/162) of women (33 ± 3.9 years) responded, with 59% primiparous. Proportions of participants that were very satisfied with their overall pregnancy, hospital stay, and postpartum care were 91%, <50%, and 85%, respectively. Both survey and qualitative data identified high satisfaction with emotional care and time afforded to discuss concerns during appointments. High levels of satisfaction can be achieved in women of low obstetric risk through the provision of GPO-midwife led multidisciplinary care throughout the maternity journey.
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Affiliation(s)
- Sharon Lisa Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- One For Women, Mt Lawley, Western Australia, Australia
| | - Jennifer Miraudo
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Alethea Rea
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna Tracy Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Stuart Anthony Prosser
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
- One For Women, Mt Lawley, Western Australia, Australia
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Douglas P. Re-thinking lactation-related nipple pain and damage. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221087865. [PMID: 35343816 PMCID: PMC8966064 DOI: 10.1177/17455057221087865] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple-areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple-areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Possums & Co., Brisbane, QLD, Australia
- Pamela Douglas, c/o Possums & Co., PO Box 5139, Brisbane, West End QLD 4101, Australia.
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Douglas P. Re-thinking benign inflammation of the lactating breast: Classification, prevention, and management. WOMEN'S HEALTH 2022; 18:17455057221091349. [PMID: 35441543 PMCID: PMC9024158 DOI: 10.1177/17455057221091349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as benign inflammation of the lactating breast remain a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for benign inflammatory conditions of the lactating breast which lack agreed or evidence-based aetiology, definitions, and treatment. This article is the second in a three-part series. This second review analyses the heterogeneous research literature concerning benign lactation-related breast inflammation from the perspectives of the mechanobiological model and complexity science, to re-think classification, prevention, and management of lactation-related breast inflammation. Benign lactation-related breast inflammation is a spectrum condition, either localized or generalized. Acute benign lactation-related breast inflammation includes engorgement and the commonly used but poorly defined diagnoses of blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, and mastitis. End-stage (non-malignant) lactation-related breast inflammation presents as the active inflammations of abscess, fistula, and septicaemia, and the inactive condition of a galactocoele. The first preventive or management principle of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents strain and rupture of a critical mass of lactocyte tight junctions. This is achieved by frequent and flexible milk removal. The second preventive or management principle is elimination of the mechanical forces which result in high intra-alveolar pressures. This requires elimination of conflicting vectors of force upon the nipple and breast tissue during milk removal; avoidance of focussed external pressure applied to the breast, including avoidance of lump massage or vibration; and avoidance of other prolonged external pressures upon the breast. Three other key preventive or management principles are discussed. Conservative management is expected to be effective for most, once recommendations to massage or vibrate out lumps, which worsen micro-vascular trauma and inflammation, are ceased.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- The Possums Clinic, Brisbane, QLD, Australia
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Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075907. [PMID: 35156466 PMCID: PMC8848036 DOI: 10.1177/17455065221075907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/29/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022]
Abstract
Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as inflammation of the lactating breast remains a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for inflammatory conditions of the lactating breast, such as engorgement, blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, mastitis and white spots, which lack agreed or evidence-based aetiology, definitions and treatment. This is the first in a series of three articles which review the research literature concerning benign lactation-related breast inflammation. This article investigates aetiological models. A complex systems perspective is applied to analyse heterogeneous and interdisciplinary evidence elucidating the functional anatomy and physiology of the lactating breast; the mammary immune system, including the human milk microbiome and cellular composition; the effects of mechanical forces during lactation; and the interactions between these. This analysis gives rise to a mechanobiological model of breast inflammation, in which very high intra-alveolar and intra-ductal pressures are hypothesized to strain or rupture the tight junctions between lactocytes and ductal epithelial cells, triggering inflammatory cascades and capillary dilation. Resultant elevation of stromal tension exerts pressure on lactiferous ducts, worsening intraluminal backpressure. Rising leucocyte and epithelial cell counts in the milk and alterations in the milk microbiome are signs that the mammary immune system is recruiting mechanisms to downregulate inflammatory feedback loops. From a complex systems perspective, the key mechanism for the prevention or treatment of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents a critical mass of mechanical strain and rupture of the tight junctions between lactocytes and ductal epithelial cells.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Possums & Co., Brisbane, QLD, Australia
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