Infant Sleep Hazards and the Risk of Sudden Unexpected Death in Infancy

OBJECTIVE

To examine the effects of infant sofa-sleeping, recent use by caregivers of alcohol, cannabis, and/or other drugs, and bed type and pillows, on the risk of sudden unexpected death in infancy (SUDI) in New Zealand.

STUDY DESIGN

A nationwide prospective case-control study was implemented between March 2012 and February 2015. Data were collected during interviews with parents/caregivers. "Hazards" were defined as infant exposure to 1 or more of sofa-sleeping and recent use by caregivers of alcohol, cannabis, and other drugs. The interaction of hazards with tobacco smoking in pregnancy and bed sharing, including for very young infants, and the difference in risk for Māori and non-Māori infants, also were assessed.

RESULTS

The study enrolled 132 cases and 258 controls. SUDI risk increased with infant sofa-sleeping (imputed aOR [IaOR] 24.22, 95% CI 1.65-356.40) and with hazards (IaOR 3.35, 95% CI 1.40-8.01). The SUDI risk from the combination of tobacco smoking in pregnancy and bed sharing (IaOR 29.0, 95% CI 10.10-83.33) increased with the addition of 1 or more hazards (IaOR 148.24, 95% CI 15.72-1398), and infants younger than 3 months appeared to be at greater risk (IaOR 450.61, 95% CI 26.84-7593.14).

CONCLUSIONS

Tobacco smoking in pregnancy and bed sharing remain the greatest SUDI risks for infants and risk increases further in the presence of sofa-sleeping or recent caregiver use of alcohol and/or cannabis and other drugs. Continued implementation of effective, appropriate programs for smoking cessation, safe sleep, and supplying safe sleep beds is required to reduce New Zealand SUDI rates and SUDI disparity among Māori.

The transition process: joint responsibility of nurse educators and employers

The transition between school and work is a time of critical development for the beginning practitioner. Have nurse neophytes been set up for failure by academics? Are seasoned practitioners and administrators "eating our young" in service settings? What must be done to prepare confident and competent beginning practitioners? What must be done to ensure a working environment that encourages and nurtures the development of young nurses? Results of a brief survey conducted to determine if Canadian university schools of nursing invite feedback about competencies of new graduates, and a review of literature published about the subject, reveal that there is a limited interface in evaluating competencies of new graduates between university schools of nursing and clinical practice agencies. This paper discusses common issues in evaluation of new baccalaureate graduates' performance from the perspective of educators and employers. This paper also discusses issues related to the evaluation of new graduates as they are documented in the literature, findings of the aforementioned survey, and implications of the findings for nurse administrators and nurse educators.

Women, breast lump discovery, and associated stress

To learn about anxiety experienced by women before they undergo breast biopsy, we surveyed by telephone 42 females aged 18 or over who were scheduled for this procedure. Unlike other studies, the present investigation explores retrospectively the impact of the discovery of a breast lump, hospitalization, and factors that aggravate and alleviate anxiety. An interview guide and an adaptation of the Spielberger, Gorsuch, and Lushene (1970) State Trait Anxiety Inventory Scale were used for data collection. The stress and coping models developed by Lazarus and Launier (1978) and Lazarus and Folkman (1984) contributed to the conceptual framework used in this study. Findings indicate that the anxiety levels of women after the discovery of a breast lump and prior to knowledge of biopsy results were extremely high. Age and time delay in contacting the physician had a statistically significant relationship on the participants' stress levels. The findings provide information that contributes to understanding the problem of anxiety originating from the discovery of a breast lump.