Search Results (39)

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time. Full article

The present study examined the relationship between sleep duration and eating behaviours, stress symptoms, and burnout in healthcare professionals. Objective: The present study aimed to examine whether sleep duration influenced the psychosocial well-being of healthcare personnel, as well as to identify possible predictors and patterns of vulnerability in this population. Method: A cross-sectional study was conducted with a sample of 194 public healthcare workers (mainly women and nursing staff). Validated questionnaires were used: the EAT-40, the EDI, the MBI, and a stress symptom scale. The participants were classified into two groups according to their sleep duration (fewer than six hours of sleep and six hours or more of sleep). Results: A sleep duration of fewer than six hours was associated with higher levels of depersonalisation (burnout), physical and emotional symptoms of stress (fatigue, tachycardia, memory loss, crying easily), dysfunctional coping strategies (self-medication, isolation), and more restrictive eating behaviours. A regression analysis identified seven predictors of sleep duration: allergies, marital status, hours worked, depersonalisation, alcohol consumption, interpersonal distrust, and skipping meals, which together explained 18% of the variance. A network analysis showed positive correlations between these variables in the group with a shorter sleep duration, indicating a pattern of cumulative psychosocial vulnerability. Conclusions: Although the cross-sectional design limits causal inference, the results underscore the importance of sleep as a key factor in the emotional and functional well-being of healthcare personnel. Organisational interventions focused on promoting rest, emotional management, and stress prevention are suggested, considering sleep not only as a biological need, but also as a relevant indicator of psychosocial health for healthcare quality. Full article

Background: Infantile colic affects up to 40% of otherwise healthy infants and can severely distress caregivers. Manual therapies are increasingly employed as non-pharmacological options, yet their effectiveness and safety remain uncertain. Methods: A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported following PRISMA-ScR. Five databases (MEDLINE, CENTRAL, Scopus, PEDro, Web of Science) were searched from December 2024 to May 2025 without restrictions at the search stage; however, only English-language randomised controlled trials published from 2012 onwards were included at the eligibility stage to ensure consistency and focus on the most recent body of evidence. Randomised controlled trials (RCTs) evaluating hands-on interventions for infants ≤ 6 months with colic were eligible. Two reviewers independently screened records, charted data, and grouped outcomes narratively. Results: Seven RCTs investigated abdominal massage, paediatric Tuina, craniosacral therapy, chiropractic manipulation, osteopathic light touch, reflexology, and acupressure. Five trials reported statistically or clinically significant reductions in daily crying (0.6–6.6 h) compared with usual care or sham. Three studies also documented meaningful gains in sleep duration (1.1–2.8 h). Parent-reported satisfaction improved in most interventions. No serious adverse events were recorded, although safety monitoring was inconsistently reported. Substantial heterogeneity in diagnostic criteria, outcome measures, and intervention dose precluded meta-analysis. Conclusions: Low-force manual therapies may offer modest short-term relief for colicky infants and improve parental experience, with an apparently favourable safety profile. However, methodological variability and small sample sizes limit certainty. Standardised protocols, objective outcome measures, and robust adverse-event surveillance are priorities for future research. Full article

Background/Objectives: Providing appropriate treatment for pediatric patients after traffic accidents remains a significant challenge. Furthermore, limited studies have validated the long-term effectiveness and safety of integrative Korean medicine treatment (IKMT) based on follow-up periods of 6 months or longer for pediatric patients. Methods: A retrospective chart review was conducted, focused on children aged 0–6 years who visited one of seven Korean medicine hospitals after traffic accident injuries and received IKMT between 1 January 2019 and 30 June 2023. The primary outcome was the Numeric Rating Scale (NRS) scores of chief complaints, and the secondary outcomes were quality of life, adverse events, and satisfaction with IKMT. Statistical analyses were conducted using paired t-tests and descriptive statistics, with a significance level of 5%. Results: Sixty-four participants were included in the retrospective chart review, and fifty-seven guardians responded to the surveys (mean age: 4.84 ± 1.26 years; mean duration of treatment: 19.20 ± 25.38 days). Among the immediate symptoms after the accidents, flashbacks and intrusive symptoms as well as nightmares and crying were the most common (50.9%). Following treatment, the NRS scores for flashbacks and intrusive symptoms and for nightmares and crying showed meaningful improvements from the time right after the accidents to the survey period. Follow-up confirmed that quality of life scores on all dimensions corresponded with those of healthy children. Nine adverse events were reported, and the participants fully recovered without the need for additional treatment. Furthermore, 91.2% of the survey respondents were satisfied with IKMT. Conclusions: IKMT was effective and safe for alleviating the post-accident symptoms in infants and young children aged 0–6 years involved in traffic accidents. Full article

The sleep–wake rhythm, regulated by the suprachiasmatic nucleus (SCN) and peripheral clocks, is influenced by light, nutrition, stress, and exercise. Recent findings suggest that estrogen receptors in the SCN may link ovarian hormone regulation to circadian rhythms, highlighting the need to consider hormonal fluctuations throughout the menstrual cycle when examining the effects of exercise on the sleep–wake rhythm in females. Therefore, we conducted a scoping review to compile existing studies involving human participants, aiming to provide a foundation for research focused on the specific physiological phenomena in females. Based on 228 literature sources, only 6 met the inclusion criteria. Despite variations in the exercise type, intensity, and duration, transient exercise demonstrated a significant impact on the expression of the clock genes BMAL1, PER2, and CRY1, suggesting their susceptibility to such activities. This review highlights the absence of studies examining the effects of exercise on clock gene expression in females, particularly in relation to menstrual cycles and ovarian hormone fluctuations, emphasizing the need for future investigations that incorporate these factors. Full article

Background and Objectives: Circumcision is the most frequently performed surgery in male pediatric patients. The postoperative period is characterized by significant pain due to the sensitivity of the foreskin and low pain threshold in children. This study aimed to evaluate the effects of sacral erector spinae plane block (S-ESPB) and ring block on postoperative face, legs, activity, cry, and consolability (FLACC) pain scores after circumcision in children. We also assessed the amount of rescue analgesia used, the time to the first administration of rescue analgesia, potential problems, and parental satisfaction. Materials and Methods: This study was a prospective, randomized, multicenter trial conducted at two tertiary healthcare centers in Turkey. The patients were divided into two groups: Group S (patients who received the S-ESPB) and Group R (patients who received the ring block). The primary outcome measure was the FLACC score at 1 h postoperatively. Secondary outcome measures included FLACC scores at 0, 2, 4, and 6 h after surgery, the total dose of rescue analgesia, time to first rescue analgesia, complications, and parental satisfaction. Results: Group S exhibited significantly lower FLACC scores than Group R at all time (0, 1, 2, 4, and 6 h) points (respectively, p = 0.013, p < 0.001, p = 0.004, p = 0.006, and p = 0.002). Group S required significantly less rescue analgesia and exhibited a significantly longer duration of analgesic efficacy compared to Group R (p = 0.001 and p = 0.002, respectively). Conclusions: The S-ESPB is a safe and effective form of analgesia for managing pain following pediatric circumcision surgery. Full article

Introduction: Lidocaine–prilocaine cream effectively reduces vaccination pain, improving vaccination adherence and advocating for its routine use in healthcare settings. Methods: This review used PRISMA guidelines and the PICOT format to structure the analysis. The focus was on paediatric patients aged 0–12 months requiring intramuscular vaccinations, comparing the application of lidocaine–prilocaine cream to other interventions or no treatment. Data sources included MEDLINE, PUBMED, EMBASE, BMC, Research GATE, and Cochrane Library. Studies were selected based on predefined inclusion and exclusion criteria, with data extracted regarding participant demographics, pain assessment scales, and study conclusions. The Cochrane Risk of Bias Tool assessed study quality, while statistical analyses evaluated the effectiveness of the intervention. Results: Fifty studies were identified, with nine ultimately included in the analysis, involving 704 participants. The primary outcome was the effectiveness of lidocaine–prilocaine cream in reducing pain after vaccinations. Results showed a significant mean difference of −1.719 in pain scores for infants treated with lidocaine–prilocaine compared to those receiving other interventions. Behavioural indicators, such as crying duration and latency to the first cry, favoured the lidocaine–prilocaine group. Conclusions: Lidocaine–prilocaine cream effectively reduces vaccination pain, supporting its routine use in healthcare settings. Engaging parents can enhance vaccination adherence. Training healthcare professionals on lidocaine–prilocaine cream application and pain scales is vital for improving patient satisfaction. Further research is needed to evaluate the long-term effects of lidocaine–prilocaine cream on vaccination experiences and infant behavioural health. Full article

The effect of caffeine on the behavior and sleep patterns of zebrafish larvae, as well as its underlying mechanisms, has been a topic of great interest. This study aimed to investigate the impact of caffeine on zebrafish larval sleep/wake behavior and the expression of key regulatory genes such as cAMP-response element binding protein (CREB) and adenosine (ADA) in the sleep pathway. To begin, the study determined the optimal dose and duration of caffeine exposure, with the optimal doses found to be 31.25 μM, 62.5 μM, and 120 μM. Similarly, the optimal exposure time was established as no more than 120 h, ensuring a mortality rate of less than 10%. The confirmation of these conditions was achieved through the assessment of angiogenesis and the inflammatory reaction. As a result, the treatment time point of 24 h post-fertilization (hpf) was selected to examine the effects of caffeine on zebrafish larval sleep rhythm (48 h, with a light cycle of 14:10). Furthermore, the study analyzed the expression of clock genes (bmal1a, per1b, per2, per3, cry2), adenosine receptor genes (adora1a, adora1b, adora2aa, adora2ab, adora2b), and key regulatory factors (CREB and ADA). The research confirmed that caffeine could induce sleep pattern disorders, significantly upregulate adenosine receptor genes (adora1a, adora1b, adora2a, adora2ab, adora2b) (p < 0.05), and markedly decrease the total sleep time and sleep efficiency of the larvae. Additionally, the activity of ADA significantly increased during the exposure (p < 0.001), and the tissue-specific expression of CREB was also significantly increased, as assessed by immunofluorescence. Caffeine may regulate circadian clock genes through the ADA/ADORA/CREB pathway. These findings not only enhance our understanding of the effects of caffeine on zebrafish larvae but also provide valuable insights into the potential impact of caffeine on human behavior and sleep. Full article

Transgenic poplars have been used to control quarantine pests worldwide, such as the fall webworm (Hyphantria cunea, FW). However, the studies on the resistance mechanism of FW to Cry toxins are limited. This study obtained an FW strain with 45-fold resistance to Cry1Ab toxin by continuous screening in the laboratory. The resistance to Cry1Ab was autosomally completely recessive, and it had approximately 40-fold cross-resistance to Cry1Ac but no cross-resistance to Cry2Ab toxin. Analysis of indoor population life tables for the resistant and susceptible strains found no significant difference in the net reproduction rate (R₀) between the two strains. The resistant strain had an insignificantly longer larval development duration and a comparable pupation rate, pupal weight, emergence rate, eggs laidper female, and egg hatching rate compared to the susceptible strain. This indicated that there was no fitness cost for Cry1Ab resistance. Our study helps in evaluating the risk of resistance to Cry1Ab toxin and the mechanisms of resistance to Cry1Ab toxin in FW. Full article

Studies suggest that dogs exhibit prosocial behaviors toward humans and can rescue their guardians trapped in a box. We investigated whether dogs could communicate with an experimenter to gain access to a crying actor (the crying condition) who was visible but inaccessible, as she remained behind a fence throughout the test, or when she was simply speaking (the neutral condition). This experimenter was positioned to allow access to the actor, and the dog was free to move within the environment. Our findings indicate that dogs alternated their gazes more frequently between the actor and the experimenter, as well as between the actor and the dog’s guardian when the inaccessible actor was crying. Furthermore, the number of gazes at the guardian and the actor, as well as the duration of gazing at the actor, were greater in the crying condition. Dogs also remained closer to the actor during the crying condition. Our results suggest the dog made more communicative signals in the crying condition, bringing to light the possibility that this communication was being used as a tool to exhibit prosocial behaviors toward the actor. Full article

Deprivation of sleep (DS) and its effects on circadian rhythm gene expression are not well understood despite their influence on various physiological and psychological processes. This study aimed to elucidate the changes in the expression of circadian rhythm genes following a night of sleep and DS. Their correlation with sleep architecture and physical activity was also examined. The study included 81 participants who underwent polysomnography (PSG) and DS with actigraphy. Blood samples were collected after PSG and DS. Expression levels of brain and muscle ARNT-like 1 (BMAL1), circadian locomotor output cycles kaput (CLOCK), neuronal PAS domain protein 2 (NPAS2), period 1 (PER1), cryptochrome 1 (CRY1) and nuclear receptor subfamily 1 group D member 1 (NR1D1) were analyzed using qRT-PCR. DS decreased the expression of CLOCK and BMAL1 while increasing PER1. PER1 expression correlated positively with total sleep time and non-rapid-eye-movement (NREM) sleep duration and negatively with sleep latency, alpha, beta and delta waves in the O1A2 lead. Physical activity during DS showed positive correlations with CLOCK, BMAL1, and CRY1. The findings highlight the role of PER1 in modulating sleep patterns, suggesting potential targets for managing sleep-related disorders. Further research is essential to deepen the understanding of these relationships and their implications. Full article

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU. Full article

Introduction: Percutaneous tenotomy of the Achilles tendon is a procedure that is part of the Ponseti method for clubfoot correction. The need to apply general anesthesia or sedation for this procedure is controversial. The objective of this study is to compare the acute stress generated in infants by percutaneous Achilles tenotomy under local anesthesia vs. peripheral line placement. Material and methods: This cross-sectional study compares the discomfort experienced by 85 infants undergoing percutaneous Achilles tenotomy with local anesthesia with that experienced by 39 infants undergoing peripheral line placement. The following parameters were determined: the duration of the procedure, crying time, average crying intensity, and maximum crying intensity. Other data recorded included the infant’s age and complications arising during the procedure. Results: The mean ages of these patients were 1.95 and 2.18 months, respectively. The following data were obtained: the mean duration of the procedure for Group A was 8.13 s and for Group B it was 127.43 s; the mean duration of crying for Group A was 84.24 s and for Group B it was 195.82 s; the mean intensity of crying for Group A was 88.99 dB and for Group B it was 100.98 dB; and the maximum crying intensity for Group A was 96.56 dB and for Group B it was 107.76 dB. Conclusions: Percutaneous Achilles tenotomy can be safely performed as an outpatient procedure, under local anesthesia. This method generates less discomfort than peripheral line placement. Full article

Background: Insomnia is increasingly recognized for its marked impact on public health and is often associated with various adverse health outcomes, including cardiovascular diseases and mental health disorders. The aim of this study was to investigate the efficacy of pre-sleep dim light therapy (LT) as a non-pharmacological intervention for insomnia in adults, assessing its influence on sleep parameters and circadian rhythms. Methods: A randomized, open-label, two-arm clinical trial was conducted over two weeks with 40 participants aged 20–60 years, all of whom had sleep disorders (CRIS, KCT0008501). They were allocated into control and LT groups. The LT group received exposure to warm-colored light, minimizing the blue spectrum, before bedtime. The study combined subjective evaluation via validated, sleep-related questionnaires, objective sleep assessments via actigraphy, and molecular analyses of circadian clock gene expression in peripheral blood mononuclear cells. Baseline characteristics between the two groups were compared using an independent t-test for continuous variables and the chi-squared test for categorical variables. Within-group differences were assessed using the paired t-test. Changes between groups were analyzed using linear regression, adjusting for each baseline value and body mass index. The patterns of changes in sleep parameters were calculated using a linear mixed model. Results: The LT group exhibited significant improvements in sleep quality (difference in difference [95% CI]; −2.00 [−3.58, −0.43], and sleep efficiency (LT: 84.98 vs. control: 82.11, p = 0.032), and an advanced Dim Light Melatonin Onset compared to the control group (approximately 30 min). Molecular analysis indicated a significant reduction in CRY1 gene expression after LT, suggesting an influence on circadian signals for sleep regulation. Conclusions: This study provides evidence for the efficacy of LT in improving sleep quality and circadian rhythm alignment in adults with insomnia. Despite limitations, such as a small sample size and short study duration, the results underscore the potential of LT as a viable non-pharmacological approach for insomnia. Future research should expand on these results with larger and more diverse cohorts followed over a longer period to validate and further elucidate the value of LT in sleep medicine. Trial registration: The trial was registered with the Clinical Research Information Service (KCT0008501). Full article

Infants born sick or preterm and admitted to the neonatal intensive care unit (NICU) face challenges to their sleep and the establishment of breastfeeding. The reported sleep patterns of NICU graduates are conflicting, and there is evidence of bi-directional relationships between infant feeding and sleep challenges and poor maternal mental health. A prospective observational longitudinal cohort study was conducted on mothers of sick/preterm infants with ≥ 5 days admission to the NICU. Participants were recruited at discharge, with follow up at 2 and 6 weeks, and 3, 6, and 9 months. Infant sleep, settle and cry patterns, maternal bother with infant behaviours, and maternal confidence were measured using the Sleep and Settle Questionnaire (SSQ). Feeding information was obtained, and breastfeeding confidence was measured using the Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF). Our sample consisted of 94 mothers of 101 sick/preterm infants. The range of infant birth gestations was 23–42/40 weeks, with n = 37 (36.6%) born < 33/40 weeks, n = 26 (25.7%) born at 33 to 36⁺⁶/40 weeks, and n = 38 (37.6%) born ≥ 37 weeks. The NICU length of stay was 5–173 days. Linear mixed modelling was used to examine associations between maternal bother and infant feeding and sleep variables. Night waking frequency (p < 0.001), durations of crying (day, evening, night; all p ≤ 0.001), and durations of settling (evening, p = 0.010) were positively associated with increased maternal bother scores. Maternal confidence was negatively associated with maternal bother (p < 0.001). The median BSES-SF score at discharge was 59/70, with 49.5% of mothers no longer breastfeeding by 6 months. Maternal bother did not differ according to feeding method (p = 0.44), or birth gestation subgroup (i.e., born < 33 weeks, 33 to 36⁺⁶ weeks, or term sick) (p = 0.44). Whether NICU infants were term sick or preterm was not associated with maternal concern with infant sleep and settling patterns in the 9 months after hospital discharge. Mothers of sick/preterm infants reported greater bother with increased night waking and longer durations of crying and evening settling. The findings from this study can inform individualised anticipatory guidance and support for this vulnerable population. Full article